Provider Demographics
NPI:1275589848
Name:WI INSTITUTE FOR NEUROLOGIC & SLEEP DISORDERS, SC
Entity Type:Organization
Organization Name:WI INSTITUTE FOR NEUROLOGIC & SLEEP DISORDERS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NAUSIEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-219-7462
Mailing Address - Street 1:945 N 12TH ST
Mailing Address - Street 2:SUITE 4602
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1305
Mailing Address - Country:US
Mailing Address - Phone:414-219-7450
Mailing Address - Fax:414-219-5503
Practice Address - Street 1:945 N 12TH ST
Practice Address - Street 2:SUITE 4602
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1305
Practice Address - Country:US
Practice Address - Phone:414-219-7450
Practice Address - Fax:414-219-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI357021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32753100Medicaid
WIH53205Medicare UPIN
WIB54536Medicare UPIN
WII13714Medicare UPIN
WI65005Medicare ID - Type UnspecifiedLAKE GENEVA CLINIC
WIB55317Medicare UPIN
WI32753100Medicaid
WI01550Medicare ID - Type UnspecifiedMILW CLINIC ID