Provider Demographics
NPI:1831102540
Name:WISCONSIN BONE & JOINT S C
Entity Type:Organization
Organization Name:WISCONSIN BONE & JOINT S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAUWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-257-2525
Mailing Address - Street 1:2500 NORTH MAYFAIR RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-257-2525
Mailing Address - Fax:414-257-1772
Practice Address - Street 1:2500 NORTH MAYFAIR RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-257-2525
Practice Address - Fax:414-257-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32897200Medicaid
WI000001833Medicare PIN
WI1009700001Medicare NSC
WI32897200Medicaid