Provider Demographics
NPI:1033164462
Name:NEUROLOGY-NEURODIAGNOSTIC CENTER, S.C.
Entity Type:Organization
Organization Name:NEUROLOGY-NEURODIAGNOSTIC CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THULASIRAMAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAVICHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-382-8960
Mailing Address - Street 1:2025 W OKLAHOMA AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4455
Mailing Address - Country:US
Mailing Address - Phone:414-382-8960
Mailing Address - Fax:414-382-8975
Practice Address - Street 1:2025 W OKLAHOMA AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4455
Practice Address - Country:US
Practice Address - Phone:414-382-8960
Practice Address - Fax:414-382-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0000020001Medicare PIN