Provider Demographics
NPI:1972688240
Name:NEUROLOGICAL SURGERY CONSULTANTS, LTD
Entity Type:Organization
Organization Name:NEUROLOGICAL SURGERY CONSULTANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:HUDSON
Authorized Official - Last Name:DECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-961-0089
Mailing Address - Street 1:2025 E NEWPORT AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2906
Mailing Address - Country:US
Mailing Address - Phone:414-961-0089
Mailing Address - Fax:414-961-1043
Practice Address - Street 1:13133 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2419
Practice Address - Country:US
Practice Address - Phone:414-961-0089
Practice Address - Fax:414-961-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24495174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30464900Medicaid
WI30464900Medicaid