DR. BRIAN EDMUND WALCZAK (NPI# 1538366158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538366158 |
| Entity Type | Individual |
| Full Name | DR. BRIAN EDMUND WALCZAK |
| Credential | DO |
| Practice Address |
621 Science Dr Madison WI 53711-1074 |
| Mailing Address |
7974 Uw Health Ct Middleton WI 53562-5531 |
| Practice Telephone | 6082638850 |
| Practice Fax Number | 6082658340 |
| Mailing Telephone | 6088295485 |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2016-11-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 106196 | MN | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 5101017411 | MI | Allopathic & Osteopathic Physicians |
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
518269 | WI | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740501774 | Brian Joseph Walczak | Dentist | 811 W Wellington Ave, Chicago, IL 60657-5123 | 2010-06-14 |
| Street Address |
621 SCIENCE DR |
| City | MADISON |
| State | WI |
| Zip Code | 53711-1074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811992886 | Tamara A Scerpella | Orthopaedic Surgery | 621 Science Dr, Madison, WI 53711-1074 | 2005-06-16 |
| 1578111365 | Laura Muller | Physical Therapist | 621 Science Dr, Madison, WI 53711-1074 | 2019-08-27 |
| 1538720701 | Kayla M Sukup | Physical Therapist | 621 Science Dr, Madison, WI 53711-1074 | 2019-06-27 |
| 1851954960 | Steven M Gloe | Massage Therapist | 621 Science Dr, Madison, WI 53711-1074 | 2019-04-16 |
| 1962996033 | Keith Alan Knurr | Physical Therapist | 621 Science Dr, Madison, WI 53711-1074 | 2018-06-21 |
| 1962931212 | Melissa A Ball | Physical Therapist | 621 Science Dr, Madison, WI 53711-1074 | 2017-06-09 |
| 1073041786 | Jamie Tasco | Specialist/Technologist | 621 Science Dr, Madison, WI 53711-1074 | 2017-05-24 |
| 1083141220 | Cassie Lynn Raduka | Physical Therapist | 621 Science Dr, Madison, WI 53711-1074 | 2017-05-18 |
| 1972954667 | Corey Block | Physical Therapist | 621 Science Dr, Mail Stop 9150, Madison, WI 53711-1074 | 2016-06-24 |
| 1588015408 | Lauren Nicole Erickson | Physical Therapist | 621 Science Dr, Mail Stop 9150, Madison, WI 53711-1074 | 2016-06-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487296307 | Exact Sciences Laboratories, LLC | Clinical Medical Laboratory | 650 Forward Drive, Madison, WI 53711 | 2019-10-11 |
| 1508417916 | Cassandra D Pasquariello | Psychologist | Department of Athletics, 1440 Monroe Street, Madison, WI 53711 | 2019-09-26 |
| 1972161628 | Leah Bastian | Marriage & Family Therapist | 2935 S Fish Hatchery Rd # 244, Madison, WI 53711 | 2019-05-29 |
| 1457810673 | Leah Smith | Specialist/Technologist | 1436 Monroe Street, Madison, WI 53711 | 2019-03-18 |
| 1669942249 | Patrick Soltvedt Bohn | Physician Assistant | 1034 Waban Hill, Madison, WI 53711 | 2018-11-27 |
| 1760975395 | Alysha Rolli | Dentist | 2945 Triverton Pike Dr, Fitchburg, WI 53711 | 2018-06-08 |
| 1265922561 | Farence Rogers | Student in an Organized Health Care Education/Training Program | 1475 Engineering Dr. Madison, Madison, WI 53711 | 2018-05-14 |
| 1588015358 | Kristen Siskovich | Speech-Language Pathologist | 2927 Fish Hatchery Rd., Fitchburg, WI 53711 | 2016-06-23 |
| 1598132383 | Shari Eberhardt | Nurse Practitioner | Journey Mental Health Center, 25 Kessel Ct, Madison, WI 53711 | 2015-08-27 |
| 1649646506 | Oak Park Place of Nakoma, LLC | Skilled Nursing Facility | 4327 Nakoma Road, Madison, WI 53711 | 2015-08-14 |
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| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619536323 | Collegiate Sports Care, LLC | Orthopaedic Surgery | 345 Main St Ste 201, Madison, NJ 07940-2339 | 2019-06-07 |
| 1811992886 | Tamara A Scerpella | Orthopaedic Surgery | 621 Science Dr, Madison, WI 53711-1074 | 2005-06-16 |
| 1538716725 | Jessica Lynn Flood | Orthopaedic Surgery | 4602 Eastpark Blvd, Madison, WI 53718-2002 | 2019-08-22 |
| 1922322429 | Andrea M. Spiker | Orthopaedic Surgery | 4602 Eastpark Blvd, Madison, WI 53718-2002 | 2010-03-26 |
| 1871753517 | Brian Foley Grogan | Orthopaedic Surgery | 4602 Eastpark Blvd, Madison, WI 53718-2002 | 2008-06-16 |
| 1295939601 | Geoffrey S. Baer | Orthopaedic Surgery | 600 Highland Ave, Madison, WI 53792-0001 | 2007-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144464199 | Lyall Carlton Stilp II | Orthopaedic Surgery | 2133 Willow Ln, Oshkosh, WI 54902-9121 | 2009-04-21 |
| 1992953921 | William David Jones | Orthopaedic Surgery | 1554 River Pines Dr, Green Bay, WI 54311-5648 | 2008-09-03 |
| 1588639256 | Albert J Cecchini | Orthopaedic Surgery | 3119 Woodman Dr, Altoona, WI 54720-2668 | 2006-02-17 |
| 1154883593 | Kristin K. Lietzau | Orthopaedic Surgery | Beloit Clinic, 1905 E. Huebbe Parkway, Beloit, WI 53511-1842 | 2019-04-04 |
| 1154839140 | Sandra Koester | Orthopaedic Surgery | 1111 Delafield St, Waukesha, WI 53188 | 2018-01-12 |
| 1750736120 | Orthopaedic Centers of Wisconsin, S.c. | Orthopaedic Surgery | 500 Vincent St, Stevens Point, WI 54481-1842 | 2016-05-04 |
| 1740549773 | Community Health Network Inc | Orthopaedic Surgery | 191 Memorial Dr, Berlin, WI 54923-1241 | 2012-05-11 |
| 1306013834 | Patrick Walter Jost | Orthopaedic Surgery | 1218 W Kilbourn Ave, Suite 301, Milwaukee, WI 53233-1330 | 2008-05-14 |
| 1083895312 | Terry Mark Roman | Orthopaedic Surgery | 123 Hospital Dr, Suite 1008, Watertown, WI 53098-3331 | 2007-11-15 |
| 1447451265 | Demetrios J Douros | Orthopaedic Surgery | 8700 W Watertown Plank Rd, Sports Medicine, Milwaukee, WI 53226-3595 | 2007-05-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.