Healthcare Provider Details

I. General information

NPI: 1568180024
Provider Name (Legal Business Name): SPINE AND BRAIN INSTITUTE OF WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 W LOOMIS RD STE 130
FRANKLIN WI
53132-8030
US

IV. Provider business mailing address

PO BOX 320425
FRANKLIN WI
53132-6071
US

V. Phone/Fax

Practice location:
  • Phone: 414-488-0678
  • Fax: 414-246-2194
Mailing address:
  • Phone: 414-488-0678
  • Fax: 414-246-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CORINNE J GIANNIOU
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 414-488-0678