MEDICARE: NEURODIAGNOSTIC CLINIC OF MILWAUKEE, SC

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	261Q00000X	Clinic/Center	30101-020	WI

General Provider Information

NPI Number	:	1477884419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURODIAGNOSTIC CLINIC OF MILWAUKEE, SC

Provider Business Mailing Address
First Line	:	6026 W LISBON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2114
Country	:	US
Telephone Number	:	414-442-3630
Fax Number	:	414-449-8552

Provider Business Practice Location Address
First Line	:	6026 W LISBON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2114
Country	:	US
Telephone Number	:	414-442-3630
Fax Number	:	414-449-8552

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RIZWANULLAH ARAIN
Credential	:	M.D.
Telephone Number	:	414-442-3630

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	01/14/2010

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