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General NPI Number Information
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NPI Number | 1336733534
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Entity Type | Organization
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Legal Business Name | MIDWEST SPINE CENTER SC
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Dates
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Enumeration Date | 02/27/2021
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Last Update Date | 02/27/2021
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Provider Practice Location Address
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Address Line | 525 W RIVER WOODS PKWY STE 240
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City | GLENDALE
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State | WI
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Zip | 53212-1010
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Country | US
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Telephone | 414-807-6128
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Fax |
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Provider Business Mailing Address
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Address Line | 611 E LAKE HILL CT
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City | MILWAUKEE
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State | WI
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Zip | 53217-4351
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Country | US
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Telephone | 414-807-6128
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES E STOLL JR.
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Credential | MD
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Telephone | 414-807-6128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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