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General NPI Number Information
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NPI Number | 1477884419
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Entity Type | Organization
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Legal Business Name | NEURODIAGNOSTIC CLINIC OF MILWAUKEE, SC
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 6026 W LISBON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53210-2114
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Country | US
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Telephone | 414-442-3630
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Fax | 414-449-8552
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Provider Business Mailing Address
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Address Line | 6026 W LISBON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53210-2114
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Country | US
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Telephone | 414-442-3630
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Fax | 414-449-8552
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Authorized Official
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Title or Position | PRESIDENT
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Name | RIZWANULLAH ARAIN
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Credential | M.D.
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Telephone | 414-442-3630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 30101-020
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License Number State | WI
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