Provider Demographics
NPI:1659494961
Name:NEUROLOGY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:NEUROLOGY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WITSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-767-7771
Mailing Address - Street 1:4500 PARK GLEN ROAD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4888
Mailing Address - Country:US
Mailing Address - Phone:952-767-7771
Mailing Address - Fax:952-767-7774
Practice Address - Street 1:4500 PARK GLEN ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4888
Practice Address - Country:US
Practice Address - Phone:952-767-7771
Practice Address - Fax:952-767-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN360612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04179Medicare PIN
MNF71756Medicare UPIN