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COMPREHENSIVE ORTHOPAEDICS SC NPI 1295717445


NPI Information

NPI: 1295717445
Provider Name: COMPREHENSIVE ORTHOPAEDICS SC
Classification: Orthopaedic Surgery - 207X00000X
Entity Type: Organization

CLIA Number: 52D2118881

Address:
7401 104TH AVE
SUITE 110
KENOSHA, WI
ZIP 53142
Phone: (262) 764-5891
Get Directions

COMPREHENSIVE ORTHOPAEDICS SC is an orthopaedic surgery in Kenosha, WI. The provider is an orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. COMPREHENSIVE ORTHOPAEDICS SC NPI is 1295717445. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

7401 104TH AVE
SUITE 110
KENOSHA, WI
ZIP 53142-845
Phone: (262) 764-5891
Fax: (262) 764-9314

The provider's authorized official is Jonathan D Main .
The authorized official title is Partner and has the following contact phone number (262) 764-5891.

The CLIA number assigned to this NPI record is 52D2118881 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/15/2005 and was last updated on 9/19/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207QS0010XFamily MedicineSports MedicineNo
2207XS0106XOrthopaedic SurgeryHand SurgeryNo
3207XS0114XOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryNo
4207XS0117XOrthopaedic SurgeryOrthopaedic Surgery of the SpineNo
5207XX0005XOrthopaedic SurgerySports MedicineNo
6208100000XPhysical Medicine & RehabilitationNo
7208VP0014XPain MedicineInterventional Pain MedicineNo
8332B00000XDurable Medical Equipment & Medical SuppliesNo
9207X00000XOrthopaedic SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
132809300MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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