MEDICARE: BLOUNT ORTHOPAEDIC ASSOCIATES, 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
2	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1831194448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOUNT ORTHOPAEDIC ASSOCIATES, S.C.

Provider Business Mailing Address
First Line	:	525 W. RIVER WOODS PARKWAY
Second Line	:	SUITE 100
City	:	GLENDALE
State	:	WI
Zip	:	53212-1010
Country	:	US
Telephone Number	:	414-332-6262
Fax Number	:	414-332-0422

Provider Business Practice Location Address
First Line	:	525 W. RIVER WOODS PARKWAY
Second Line	:	SUITE 100
City	:	GLENDALE
State	:	WI
Zip	:	53212-1010
Country	:	US
Telephone Number	:	414-332-6262
Fax Number	:	414-332-0422

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	JEAN MARIE MARSICEK
Credential	:
Telephone Number	:	414-977-1325

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	10/07/2024

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