Provider Demographics
NPI:1922086032
Name:RYDLEWICZ, JAMES ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:RYDLEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 W MORGAN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220
Mailing Address - Country:US
Mailing Address - Phone:414-321-8960
Mailing Address - Fax:414-321-0632
Practice Address - Street 1:5233 W MORGAN AVE
Practice Address - Street 2:STE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220
Practice Address - Country:US
Practice Address - Phone:414-321-8960
Practice Address - Fax:414-321-0632
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17361207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30943700Medicaid
WI1222470001Medicare NSC
WI30943700Medicaid
WI000202670Medicare PIN
WI1222470002Medicare NSC