| Organization Name: | ORTHOPEDIC & SPORTS MEDICINE SPECIALISTS OF GREEN BAY, SC |
| NPI Number: | 1760670145 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDY J SWIECICHOWSKI (ADMINISTRATOR) |
| Mailing Address: | 2223 Lime Kiln Rd Suite 1 Green Bay |
| State: | WI US |
| Postal Code: | 543116213 |
| Phone Number: | 9204308120 |
| Fax Number: | 9204308122 |
| NPI Enumeration Date: | 10/10/2007 |
| NPI Last Update Date: | 09/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |