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General NPI Number Information
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NPI Number | 1396454856
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Entity Type | Organization
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Legal Business Name | WISCONSIN CENTER FOR NEUROLOGICAL DISORDERS, S.C.
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 10750 W HOWARD AVE
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City | GREENFIELD
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State | WI
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Zip | 53228-1321
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Country | US
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Telephone | 414-460-3195
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Fax |
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Provider Business Mailing Address
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Address Line | 10750 W HOWARD AVE
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City | GREENFIELD
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State | WI
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Zip | 53228-1321
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Country | US
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Telephone | 414-460-3195
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NISHIT NIRMAL
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Credential |
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Telephone | 414-460-3195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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