Provider Demographics
NPI:1972839298
Name:NEUROTEL MANAGEMENT CO INC
Entity Type:Organization
Organization Name:NEUROTEL MANAGEMENT CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:HECOX
Authorized Official - Suffix:
Authorized Official - Credentials:M D, PH D
Authorized Official - Phone:708-220-4287
Mailing Address - Street 1:21920 W CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53146-1936
Mailing Address - Country:US
Mailing Address - Phone:708-267-4287
Mailing Address - Fax:262-521-1089
Practice Address - Street 1:21920 W CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53146-1936
Practice Address - Country:US
Practice Address - Phone:708-267-4287
Practice Address - Fax:262-521-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22860-020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty