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General NPI Number Information
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NPI Number | 1518091016
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Entity Type | Organization
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Legal Business Name | WISCONSIN NEUROSURGERY SC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 550 FOREST CT
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City | BROOKFIELD
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State | WI
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Zip | 53045-3628
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Country | US
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Telephone | 262-784-4205
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Fax | 262-784-6549
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Provider Business Mailing Address
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Address Line | 550 FOREST CT
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City | BROOKFIELD
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State | WI
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Zip | 53045-3628
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Country | US
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Telephone | 262-784-4205
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Fax | 262-784-6549
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | DR. KIMBALL SANDS FUIKS
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Credential | MD
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Telephone | 262-784-4205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 32726
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License Number State | WI
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