52D2147693 CLIA NUMBER - WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE

Laboratory Demographics

CLIA Number: 52D2147693

Facility Name: WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE

Facility Address:
1265 WEST AMERICAN DR STE 200
NEENAH, WI
ZIP 54956
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Facility Phone Number: 920 722-7747

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1578872628

Taxonomy: 208800000X - Urology
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

CLIA Record

Field Name	Field Value
CLIA Number	52D2147693
LAB Type	Ambulatory Surgery Center
Facility Name	WISCONSIN INSTITUTE OF SURGICAL EXCELLENCE
Street	1265 WEST AMERICAN DR STE 200
City	NEENAH
State	WI
ZIP	54956
Phone	920 722-7747
CertificateType	4
CertificateEffectiveDate	4/24/2024
CertificateExpirationDate	4/23/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024