Provider Demographics
NPI:1902853351
Name:SURGICAL SPECIALISTS OF DODGE CO
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF DODGE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILITELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-887-0379
Mailing Address - Street 1:705 S UNIVERSITY AVE
Mailing Address - Street 2:350
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916
Mailing Address - Country:US
Mailing Address - Phone:920-887-0379
Mailing Address - Fax:920-887-0382
Practice Address - Street 1:705 S UNIVERSITY AVE
Practice Address - Street 2:350
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916
Practice Address - Country:US
Practice Address - Phone:920-887-0379
Practice Address - Fax:920-887-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty