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General NPI Number Information
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NPI Number | 1720205826
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Entity Type | Organization
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Legal Business Name | MADISON INSTITUTE OF NEUROLOGICAL DISORDERS, SC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2711 ALLEN BLVD
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City | MIDDLETON
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State | WI
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Zip | 53562-2287
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Country | US
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Telephone | 608-821-6515
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 ALLEN BLVD
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City | MIDDLETON
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State | WI
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Zip | 53562-2287
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Country | US
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Telephone | 608-821-6515
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHERYL RAY
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Credential | MD
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Telephone | 608-821-6515
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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 |
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License Number State | WI
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