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General NPI Number Information
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NPI Number | 1790840015
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Entity Type | Organization
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Legal Business Name | VALLEY NEURO-MICRONEUROSURGERY SC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2700 W 9TH AVE SUITE 120
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City | OSHKOSH
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State | WI
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Zip | 54904-7864
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Country | US
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Telephone | 920-223-0545
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Fax | 920-223-0551
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Provider Business Mailing Address
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Address Line | 2700 W 9TH AVE SUITE 120
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City | OSHKOSH
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State | WI
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Zip | 54904-7864
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Country | US
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Telephone | 920-223-0545
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Fax | 920-223-0551
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. KAMALJIT SINGH PAUL
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Credential | MD
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Telephone | 920-223-0545
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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 | 27755
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License Number State | WI
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