MEDICARE: MILWAUKEE SPINAL SPECIALISTS, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	25408	WI

General Provider Information

NPI Number	:	1124359880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILWAUKEE SPINAL SPECIALISTS, S.C.

Provider Business Mailing Address
First Line	:	575 W. RIVER WOODS PKWY
Second Line	:	SUITE 305
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1003
Country	:	US
Telephone Number	:	414-961-2225
Fax Number	:	414-961-0298

Provider Business Practice Location Address
First Line	:	575 W. RIVER WOODS PKWY
Second Line	:	SUITE 305
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1003
Country	:	US
Telephone Number	:	414-961-2225
Fax Number	:	414-961-0298

Authorized Official
Title or Position	:	ACCOUNTS REP
Name	:	KIKI MISOVY
Credential	:
Telephone Number	:	414-961-2225

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	03/29/2016

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