Provider Demographics
NPI:1124359880
Name:MILWAUKEE SPINAL SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:MILWAUKEE SPINAL SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS REP
Authorized Official - Prefix:
Authorized Official - First Name:KIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MISOVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-961-2225
Mailing Address - Street 1:575 W. RIVER WOODS PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1003
Mailing Address - Country:US
Mailing Address - Phone:414-961-2225
Mailing Address - Fax:414-961-0298
Practice Address - Street 1:575 W. RIVER WOODS PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1003
Practice Address - Country:US
Practice Address - Phone:414-961-2225
Practice Address - Fax:414-961-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25408207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB56085Medicare UPIN
WI000002306Medicare PIN