Provider Demographics
NPI:1710520200
Name:ASPEN ORTHOPEDIC AND REHABILATION SPECALIST
Entity Type:Organization
Organization Name:ASPEN ORTHOPEDIC AND REHABILATION SPECALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-395-4141
Mailing Address - Street 1:12555 W NATIONAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4061
Mailing Address - Country:US
Mailing Address - Phone:262-395-4163
Mailing Address - Fax:262-395-4159
Practice Address - Street 1:12555 W NATIONAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4061
Practice Address - Country:US
Practice Address - Phone:262-395-4141
Practice Address - Fax:262-395-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty