Healthcare Provider Details

I. General information

NPI: 1992743397
Provider Name (Legal Business Name): MILWAUKEE NEUROLOGICAL INSTITUTE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 N 12TH ST SUITE 1800
MILWAUKEE WI
53233-1306
US

IV. Provider business mailing address

960 N 12TH ST SUITE 1800
MILWAUKEE WI
53233-1306
US

V. Phone/Fax

Practice location:
  • Phone: 414-278-9000
  • Fax: 414-278-9005
Mailing address:
  • Phone: 414-278-9000
  • Fax: 414-278-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN F. BEHM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-278-9000