=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497132054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHO SPINE SURGERY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2015
-----------------------------------------------------
Last Update Date | 01/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6226 BANKERS RD SUITE 11
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53403-9799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-939-5447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6226 BANKERS RD SUITE 11
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53403-9799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-939-5447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRANKO PRPA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 414-939-5447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------