Provider Demographics
NPI:1285791459
Name:ORTHOPAEDIC ASSOCIATES OF GREEN BAY, S.C.
Entity type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF GREEN BAY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAZZARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-569-5830
Mailing Address - Street 1:1630 COMMANCHE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5753
Mailing Address - Country:US
Mailing Address - Phone:920-468-0246
Mailing Address - Fax:920-432-9309
Practice Address - Street 1:1630 COMMANCHE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5753
Practice Address - Country:US
Practice Address - Phone:920-468-0246
Practice Address - Fax:920-432-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30646900Medicaid
WI00007390Medicare ID - Type Unspecified