Provider Demographics
NPI:1407820244
Name:MILWAUKEE ORTHOPEDIC SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:MILWAUKEE ORTHOPEDIC SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POLZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-274-7220
Mailing Address - Street 1:1575 N RIVERCENTER DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3978
Mailing Address - Country:US
Mailing Address - Phone:414-274-7220
Mailing Address - Fax:414-274-7227
Practice Address - Street 1:1575 N RIVERCENTER DR
Practice Address - Street 2:SUITE 160
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3978
Practice Address - Country:US
Practice Address - Phone:414-274-7220
Practice Address - Fax:414-274-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32841500Medicaid
WI01523Medicare ID - Type Unspecified