MEDICARE: NEUROTECH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
3	2472E0500X	EEG Technician
4	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1194283341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROTECH, LLC

Provider Business Mailing Address
First Line	:	626 W MORELAND BLVD
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53188-2433
Country	:	US
Telephone Number	:	262-875-6572
Fax Number	:	262-754-0897

Provider Business Practice Location Address
First Line	:	8050 CORPORATE CIR STE 6
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-1281
Country	:	US
Telephone Number	:	262-875-6642
Fax Number	:	262-754-0897

Authorized Official
Title or Position	:	DIRECTOR OF CONTRACTING AND RESEARC
Name	:	KRISTINE LISA WILDNER
Credential	:
Telephone Number	:	262-875-6572

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	11/12/2021

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