Provider Demographics
NPI:1275157943
Name:NEUROSPINE AND ENDOVASCULAR CENTER LLC
Entity Type:Organization
Organization Name:NEUROSPINE AND ENDOVASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:AHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-488-1111
Mailing Address - Street 1:10500 W LOOMIS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8030
Mailing Address - Country:US
Mailing Address - Phone:414-488-1111
Mailing Address - Fax:
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:414-488-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty