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General NPI Number Information
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NPI Number | 1275127375
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Entity Type | Organization
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Legal Business Name | MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 7095 S BALLPARK DR STE 100
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City | FRANKLIN
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State | WI
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Zip | 53132-6908
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Country | US
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Telephone | 414-817-6620
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1153
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City | BEDFORD PARK
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State | IL
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Zip | 60499-1153
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Country | US
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Telephone | 414-817-6620
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHEILA GANSEMER
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Credential |
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Telephone | 414-325-4589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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