MEDICARE: REGIONAL NEUROLOGY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003999681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL NEUROLOGY CENTER

Provider Business Mailing Address
First Line	:	4555 W SCHROEDER DR
Second Line	:	#170
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-1475
Country	:	US
Telephone Number	:	414-365-3210
Fax Number	:	414-365-3225

Provider Business Practice Location Address
First Line	:	5678 W BROWN DEER RD
Second Line	:	#101
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-2365
Country	:	US
Telephone Number	:	414-354-8700
Fax Number	:

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	ROSE M DOTSON
Credential	:	MD
Telephone Number	:	414-354-8700

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/24/2008

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Directions to “REGIONAL NEUROLOGY CENTER ” Practice Location

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