Provider Demographics
NPI:1487764700
Name:VAN WINKLE, GREGORY N (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:N
Last Name:VAN WINKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:N91W15750 FALLS PKWY
Mailing Address - Street 2:ORTHOPAEDIC SPORTS AND SPINE CENTER
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2301
Mailing Address - Country:US
Mailing Address - Phone:262-532-1100
Mailing Address - Fax:262-532-1409
Practice Address - Street 1:N91W15750 FALLS PKWY
Practice Address - Street 2:ORTHOPAEDIC SPORTS AND SPINE CENTER
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2301
Practice Address - Country:US
Practice Address - Phone:262-532-1100
Practice Address - Fax:262-532-1409
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI27105207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30658300Medicaid
WI1487764700Medicaid
WIWI1897108OtherMEDICARE
WIB57307Medicare UPIN
WIWI1897108OtherMEDICARE
WI680860601Medicare PIN