Provider Demographics
NPI:1497132054
Name:ORTHO SPINE SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:ORTHO SPINE SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANKO
Authorized Official - Middle Name:
Authorized Official - Last Name:PRPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-939-5447
Mailing Address - Street 1:6226 BANKERS RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9799
Mailing Address - Country:US
Mailing Address - Phone:414-939-5447
Mailing Address - Fax:
Practice Address - Street 1:6226 BANKERS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9799
Practice Address - Country:US
Practice Address - Phone:414-939-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty