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General NPI Number Information
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NPI Number | 1295127298
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Entity Type | Organization
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Legal Business Name | M ORTHO, SC
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | W62 N179 WASHINGTON AVE SUITE 3
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City | CEDARBURG
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State | WI
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Zip | 53012-2726
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Country | US
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Telephone | 262-641-3700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 410
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City | BROOKFIELD
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State | WI
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Zip | 53008-0410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTEN MASKALA
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Credential | M.D.
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Telephone | 262-641-3700
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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 | 41376
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License Number State | WI
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