Provider Demographics
NPI:1215955125
Name:BROOKFIELD SURGICAL ASSOCIATES, SC
Entity type:Organization
Organization Name:BROOKFIELD SURGICAL ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-786-3722
Mailing Address - Street 1:17000 W NORTH AVE STE 107W
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4423
Mailing Address - Country:US
Mailing Address - Phone:262-786-3722
Mailing Address - Fax:262-786-0116
Practice Address - Street 1:17000 W NORTH AVE STE 107W
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4423
Practice Address - Country:US
Practice Address - Phone:262-786-3722
Practice Address - Fax:262-786-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32751700Medicaid
WI32751700Medicaid