Provider Demographics
NPI:1477662641
Name:WEST ALLIS ORTHOPEDIC CLINIC, LTD
Entity Type:Organization
Organization Name:WEST ALLIS ORTHOPEDIC CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KRUG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-321-2255
Mailing Address - Street 1:9400 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2306
Mailing Address - Country:US
Mailing Address - Phone:414-321-2255
Mailing Address - Fax:414-321-2091
Practice Address - Street 1:9400 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2306
Practice Address - Country:US
Practice Address - Phone:414-321-2255
Practice Address - Fax:414-321-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32739600Medicaid
WI0212250001Medicare NSC
WI000001139Medicare ID - Type Unspecified