| Wisconsin Neurology Clinic, Llc | |
|
2603 W Rawson Ave Suite 128 Oak Creek WI 53154-8422 | |
| (414) 431-6760 | |
| (414) 431-6761 |
| Full Name | Wisconsin Neurology Clinic, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2603 W Rawson Ave, Oak Creek, Wisconsin |
| Authorized Official Name and Position | Virendra K Misra (OWNER) |
| Authorized Official Contact | 4144316760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisconsin Neurology Clinic, Llc 2603 W Rawson Ave Suite 128 Oak Creek WI 53154-8422 Ph: (414) 431-6760 | Wisconsin Neurology Clinic, Llc 2603 W Rawson Ave Suite 128 Oak Creek WI 53154-8422 Ph: (414) 431-6760 |
| NPI Number | 1639101405 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 10/24/2007 |
| Medicare PECOS PAC ID | 2264574052 |
|---|---|
| Medicare Enrollment ID | O20100115000731 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639101405 | NPI | - | NPPES |
| 32336900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 38580 (Wisconsin) | Primary |
| Provider Name | Virendra Misra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780648048 PECOS PAC ID: 8527001023 Enrollment ID: I20050606000955 |
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