Provider Demographics
NPI:1396454856
Name:WISCONSIN CENTER FOR NEUROLOGICAL DISORDERS, S.C.
Entity type:Organization
Organization Name:WISCONSIN CENTER FOR NEUROLOGICAL DISORDERS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NISHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIRMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-460-3195
Mailing Address - Street 1:10750 W HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1321
Mailing Address - Country:US
Mailing Address - Phone:414-460-3195
Mailing Address - Fax:
Practice Address - Street 1:10750 W HOWARD AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1321
Practice Address - Country:US
Practice Address - Phone:414-460-3195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Multi-Specialty