Provider Demographics
NPI:1366473597
Name:ASPEN ORTHOPAEDIC AND REHABILITATION SPECIALISTS S C
Entity Type:Organization
Organization Name:ASPEN ORTHOPAEDIC AND REHABILITATION SPECIALISTS S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-395-4141
Mailing Address - Street 1:12555 W NATIONAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4061
Mailing Address - Country:US
Mailing Address - Phone:262-395-4141
Mailing Address - Fax:262-395-4189
Practice Address - Street 1:12555 W NATIONAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4061
Practice Address - Country:US
Practice Address - Phone:262-395-4141
Practice Address - Fax:262-395-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICG1663OtherMEDICARE RAILROAD
WI0524750001OtherDME ADMINISTAR FEDERAL
WICG1663OtherMEDICARE RAILROAD