Provider Demographics
NPI:1558386128
Name:NEUROLOGY CONSULTANTS OF NE
Entity Type:Organization
Organization Name:NEUROLOGY CONSULTANTS OF NE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:920-430-7100
Mailing Address - Street 1:720 S VAN BUREN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3585
Mailing Address - Country:US
Mailing Address - Phone:920-430-7100
Mailing Address - Fax:920-430-7114
Practice Address - Street 1:720 S VAN BUREN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3585
Practice Address - Country:US
Practice Address - Phone:920-430-7100
Practice Address - Fax:920-430-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32837700Medicaid
WI32837700Medicaid
000007580Medicare ID - Type Unspecified