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General NPI Number Information
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NPI Number | 1972688240
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Entity Type | Organization
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Legal Business Name | NEUROLOGICAL SURGERY CONSULTANTS, LTD
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13133 N PORT WASHINGTON RD SUITE 102
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City | MEQUON
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State | WI
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Zip | 53097-2419
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Country | US
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Telephone | 414-961-0089
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Fax | 414-961-1043
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Provider Business Mailing Address
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Address Line | 2025 E NEWPORT AVE SUITE 140
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City | MILWAUKEE
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State | WI
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Zip | 53211-2906
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Country | US
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Telephone | 414-961-0089
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Fax | 414-961-1043
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK HUDSON DECKARD
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Credential | M.D.
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Telephone | 414-961-0089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24495
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License Number State | WI
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