Healthcare Provider Details

I. General information

NPI: 1023267226
Provider Name (Legal Business Name): AMBULATORY EEG RECORDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10325 N PORT WASHINGTON RD SUITE #150
MEQUON WI
53092-5764
US

IV. Provider business mailing address

PO BOX 170602
MILWAUKEE WI
53217-8051
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-1701
  • Fax:
Mailing address:
  • Phone: 262-241-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number261QS1200X
License Number StateWI

VIII. Authorized Official

Name: LESLIE K CHASE
Title or Position: CEO
Credential:
Phone: 262-241-1701