MEDICARE: ORTHOPEDIC SURGEONS OF WISCONSIN, S.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
2	207XS0117X	Orthopaedic Surgery of the Spine Physician
3	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
5	207XX0801X	Orthopaedic Trauma Physician
6	225100000X	Physical Therapist
7	363A00000X	Physician Assistant
8	363L00000X	Nurse Practitioner
9	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295769321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC SURGEONS OF WISCONSIN, S.C.

Provider Business Mailing Address
First Line	:	3111 W RAWSON AVE STE 200
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132-8890
Country	:	US
Telephone Number	:	414-384-6700
Fax Number	:	414-727-1058

Provider Business Practice Location Address
First Line	:	3077 N MAYFAIR RD STE 305
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-4305
Country	:	US
Telephone Number	:	414-384-6700
Fax Number	:	414-727-1058

Authorized Official
Title or Position	:	OFFICER AND AUTHORIZED OFFICIAL
Name	:	JENNIFER BALDOCK
Credential	:
Telephone Number	:	615-234-5954

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/20/2025

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53222-4305

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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

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