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General NPI Number Information
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NPI Number | 1972839298
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Entity Type | Organization
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Legal Business Name | NEUROTEL MANAGEMENT CO INC
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 21920 W CLEVELAND AVE
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City | NEW BERLIN
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State | WI
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Zip | 53146-1936
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Country | US
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Telephone | 708-267-4287
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Fax | 262-521-1089
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Provider Business Mailing Address
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Address Line | 21920 W CLEVELAND AVE
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City | NEW BERLIN
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State | WI
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Zip | 53146-1936
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Country | US
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Telephone | 708-267-4287
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Fax | 262-521-1089
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Authorized Official
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Title or Position | CEO
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Name | DR. KURT EVAN HECOX
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Credential | M. D., PH. D
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Telephone | 708-220-4287
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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 | 22860-020
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License Number State | WI
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