Provider Demographics
NPI:1790840015
Name:VALLEY NEURO-MICRONEUROSURGERY SC
Entity Type:Organization
Organization Name:VALLEY NEURO-MICRONEUROSURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMALJIT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-223-0545
Mailing Address - Street 1:2700 W 9TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7864
Mailing Address - Country:US
Mailing Address - Phone:920-223-0545
Mailing Address - Fax:920-223-0551
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7864
Practice Address - Country:US
Practice Address - Phone:920-223-0545
Practice Address - Fax:920-223-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27755207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31451400Medicaid
B55630Medicare UPIN
71293Medicare ID - Type Unspecified