Provider Demographics
NPI:1619018819
Name:MIDWEST SPINAL CENTER
Entity Type:Organization
Organization Name:MIDWEST SPINAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:414-962-8600
Mailing Address - Street 1:2015 E NEWPORT AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2949
Mailing Address - Country:US
Mailing Address - Phone:414-962-8600
Mailing Address - Fax:414-962-9947
Practice Address - Street 1:2015 E NEWPORT AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2949
Practice Address - Country:US
Practice Address - Phone:414-962-8600
Practice Address - Fax:414-962-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty