Provider Demographics
NPI:1083891592
Name:SPECTRUM HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SPECTRUM HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SELAHATTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KURTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-273-1209
Mailing Address - Street 1:1661 N WATER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2085
Mailing Address - Country:US
Mailing Address - Phone:414-273-1209
Mailing Address - Fax:414-273-1424
Practice Address - Street 1:1661 N WATER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2085
Practice Address - Country:US
Practice Address - Phone:414-273-1209
Practice Address - Fax:414-273-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI957-123101YM0800X
WI47803-0202084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000001686Medicare PIN