Provider Demographics
NPI:1093203770
Name:NEUROTECH, LLC
Entity Type:Organization
Organization Name:NEUROTECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING & RESEARCH
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:WILDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-875-6572
Mailing Address - Street 1:626 W MORELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2433
Mailing Address - Country:US
Mailing Address - Phone:262-754-0898
Mailing Address - Fax:262-754-0897
Practice Address - Street 1:1101 GLENDALE BLVD STE 101-B
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3775
Practice Address - Country:US
Practice Address - Phone:262-875-6592
Practice Address - Fax:262-754-0897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROTECH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-27
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier