Provider Demographics
NPI:1912329905
Name:KENOSHA HAND & PLASTIC SURGERY SC
Entity Type:Organization
Organization Name:KENOSHA HAND & PLASTIC SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRNDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-656-8237
Mailing Address - Street 1:6308 8TH AVE # 104
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-656-8237
Mailing Address - Fax:262-671-2134
Practice Address - Street 1:6308 8TH AVE # 104
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-656-8237
Practice Address - Fax:262-671-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33466020208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31835100Medicaid
WIF38749Medicare UPIN
WI31835100Medicaid