Provider Demographics
NPI:1316014855
Name:WISCONSIN NEUROPATHY CENTER LLC
Entity Type:Organization
Organization Name:WISCONSIN NEUROPATHY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CERNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-697-4301
Mailing Address - Street 1:10105 74TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7519
Mailing Address - Country:US
Mailing Address - Phone:262-697-4301
Mailing Address - Fax:262-925-8409
Practice Address - Street 1:10105 74TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7519
Practice Address - Country:US
Practice Address - Phone:262-697-4301
Practice Address - Fax:262-925-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI416025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43206800Medicaid
WI43240700Medicaid
WI31693500Medicaid
T37487Medicare UPIN
WI000032550Medicare PIN
WI31693500Medicaid
E39494Medicare UPIN
T95283Medicare UPIN
WI43206800Medicaid
WI43240700Medicaid
000280355Medicare PIN