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NPI Code Detail

MEDICARE: WI SHMH SC

MEDICARE: WI SHMH 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
12084B0040XBehavioral Neurology & Neuropsychiatry Physician

General Provider Information

NPI Number : 1841031549
Entity Type Code : Organization
Provider Name (Legal Business Name) : WI SHMH SC
Provider Business Mailing Address
First Line : 5454 FARGO AVE
Second Line :
City : SKOKIE
State : IL
Zip : 60077-3210
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18740 W BLUEMOUND RD
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-2936
Country : US
Telephone Number : 847-221-6040
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : MARTYNA KOLAREV
Credential :
Telephone Number : 773-332-7539
Provider Enumeration Date : 06/05/2024
Last Update Date : 12/22/2025

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Directions to “WI SHMH SC ” Practice Location

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