Provider Demographics
NPI:1568180024
Name:SPINE AND BRAIN INSTITUTE OF WISCONSIN LLC
Entity Type:Organization
Organization Name:SPINE AND BRAIN INSTITUTE OF WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIANNIOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-488-0678
Mailing Address - Street 1:PO BOX 320425
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-6071
Mailing Address - Country:US
Mailing Address - Phone:414-488-0678
Mailing Address - Fax:414-246-2194
Practice Address - Street 1:10500 W LOOMIS RD STE 130
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:414-488-0678
Practice Address - Fax:414-246-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty