Provider Demographics
NPI:1538507603
Name:PURATH HEADACHE & NEUROLOGY, S.C.
Entity Type:Organization
Organization Name:PURATH HEADACHE & NEUROLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PURATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-694-5000
Mailing Address - Street 1:5244 ZACHARY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9795
Mailing Address - Country:US
Mailing Address - Phone:262-694-5000
Mailing Address - Fax:
Practice Address - Street 1:565 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1254
Practice Address - Country:US
Practice Address - Phone:262-694-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40525-202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty