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General NPI Number Information
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NPI Number | 1912329905
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Entity Type | Organization
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Legal Business Name | KENOSHA HAND & PLASTIC SURGERY SC
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 10117 74TH ST STE 100
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City | KENOSHA
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State | WI
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Zip | 53142-7542
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Country | US
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Telephone | 262-656-8237
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Fax | 622-453-0882
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Provider Business Mailing Address
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Address Line | 6308 8TH AVE # 104
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City | KENOSHA
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State | WI
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Zip | 53143-5031
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Country | US
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Telephone | 262-656-8237
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Fax | 262-671-2134
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL BIRNDORF
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Credential | MD
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Telephone | 262-656-8237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 33466020
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License Number State | WI
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