Provider Demographics
NPI:1689799116
Name:MILWAUKEE HAND SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:MILWAUKEE HAND SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-258-2323
Mailing Address - Street 1:3077 N MAYFAIR RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4305
Mailing Address - Country:US
Mailing Address - Phone:414-258-2323
Mailing Address - Fax:414-258-2736
Practice Address - Street 1:3077 N MAYFAIR RD
Practice Address - Street 2:SUITE 306
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4305
Practice Address - Country:US
Practice Address - Phone:414-258-2323
Practice Address - Fax:414-258-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22545020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30741000Medicaid
WI30741000Medicaid