Provider Demographics
NPI:1063495000
Name:NEUROSURGERY AND ENDOVASCULAR ASSOC. SC.
Entity Type:Organization
Organization Name:NEUROSURGERY AND ENDOVASCULAR ASSOC. SC.
Other - Org Name:SPINE AND BRAIN IMAGING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:AHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-385-8706
Mailing Address - Street 1:PO BOX 211037
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-1037
Mailing Address - Country:US
Mailing Address - Phone:414-385-8706
Mailing Address - Fax:414-385-8777
Practice Address - Street 1:10500 W LOOMIS RD STE 120
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8030
Practice Address - Country:US
Practice Address - Phone:414-385-8700
Practice Address - Fax:414-385-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21286600Medicaid
WI02980Medicare ID - Type Unspecified