MEDICARE: NEUROTECH, LLC

Medicare Provider Information

Scope of Practice

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

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

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	:	1790199859
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	:	262-754-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 E 86TH ST STE 107
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1842
Country	:	US
Telephone Number	:	262-875-6611
Fax Number	:

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

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	04/23/2021

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Directions to “NEUROTECH, LLC ” Practice Location

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