=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952756769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPAEDIC ASSOCIATES OF WISCONSIN SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2016
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 285 S MOORLAND RD
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-303-5055
-----------------------------------------------------
Fax | 262-303-5057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N15W28300 GOLF RD
-----------------------------------------------------
City | PEWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53072-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-303-5055
-----------------------------------------------------
Fax | 262-303-5057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | JON MICHAEL ENGLUND
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 262-303-5055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------