Provider Demographics
NPI:1497794465
Name:HAND TO SHOULDER SPECIALISTS OF WISCONSIN LTD
Entity Type:Organization
Organization Name:HAND TO SHOULDER SPECIALISTS OF WISCONSIN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KLIMCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-453-7418
Mailing Address - Street 1:525 W RIVER WOODS PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1010
Mailing Address - Country:US
Mailing Address - Phone:414-453-7418
Mailing Address - Fax:414-967-1151
Practice Address - Street 1:525 W RIVER WOODS PKWY STE 230
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1010
Practice Address - Country:US
Practice Address - Phone:414-453-7418
Practice Address - Fax:414-967-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000068781Medicare PIN
WI000001442Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER