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General NPI Number Information
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NPI Number | 1447540463
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE ORTHOPEDIC SURGERY GROUP LLC
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 9120 W LOOMIS RD STE 100
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City | FRANKLIN
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State | WI
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Zip | 53132-9083
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Country | US
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Telephone | 262-939-9318
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Fax | 608-756-8617
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Provider Business Mailing Address
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Address Line | 9120 W LOOMIS RD STE 100
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City | FRANKLIN
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State | WI
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Zip | 53132-9083
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Country | US
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Telephone | 262-939-9318
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Fax | 608-756-8617
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CATHY J DEAN
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Credential |
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Telephone | 262-939-9318
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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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