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General NPI Number Information
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NPI Number | 1538507603
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Entity Type | Organization
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Legal Business Name | PURATH HEADACHE & NEUROLOGY, S.C.
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 565 MILWAUKEE AVE
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City | BURLINGTON
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State | WI
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Zip | 53105-1254
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Country | US
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Telephone | 262-694-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 5244 ZACHARY DR
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City | MOUNT PLEASANT
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State | WI
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Zip | 53403-9795
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Country | US
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Telephone | 262-694-5000
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARK RICHARD PURATH
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Credential |
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Telephone | 262-694-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 40525-20
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License Number State | WI
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