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General NPI Number Information
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NPI Number | 1649430380
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Entity Type | Organization
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Legal Business Name | FAMILY & SPORTS ORTHOPAEDIC CENTER, LLC
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 620 W BROWN ST
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City | WAUPUN
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State | WI
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Zip | 53963-1702
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Country | US
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Telephone | 920-356-1000
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Fax | 920-356-0719
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Provider Business Mailing Address
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Address Line | 118 W MAPLE AVE
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City | BEAVER DAM
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State | WI
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Zip | 53916-2104
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Country | US
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Telephone | 920-356-1000
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Fax | 920-356-0719
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CINDY DUERST
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Credential |
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Telephone | 920-356-1000
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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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