MEDICARE: NEUROTEL MANAGEMENT CO INC

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	174400000X	Specialist	22860-020	WI

General Provider Information

NPI Number	:	1972839298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROTEL MANAGEMENT CO INC

Provider Business Mailing Address
First Line	:	21920 W CLEVELAND AVE
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53146-1936
Country	:	US
Telephone Number	:	708-267-4287
Fax Number	:	262-521-1089

Provider Business Practice Location Address
First Line	:	21920 W CLEVELAND AVE
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53146-1936
Country	:	US
Telephone Number	:	708-267-4287
Fax Number	:	262-521-1089

Authorized Official
Title or Position	:	CEO
Name	:	DR. KURT EVAN HECOX
Credential	:	M. D., PH. D
Telephone Number	:	708-220-4287

Provider Enumeration Date	:	10/21/2009
Last Update Date	:	10/21/2009

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