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General NPI Number Information
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NPI Number | 1386828549
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Entity Type | Organization
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Legal Business Name | NORTHERN WISCONSIN BONE AND JOINT CENTER
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 02/22/2013
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Provider Practice Location Address
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Address Line | 611 VETERANS PARKWAY
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City | WOODRUFF
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State | WI
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Zip | 54568
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Country | US
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Telephone | 715-358-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 7520 US HIGHWAY 51 S STE A
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City | MINOCQUA
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State | WI
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Zip | 54548-8944
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Country | US
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Telephone | 715-358-1911
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Fax |
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | LISA MARIE TADYCH
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Credential |
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Telephone | 715-358-1911
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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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