Provider Demographics
NPI:1336780717
Name:NEUROTECH, LLC
Entity Type:Organization
Organization Name:NEUROTECH, LLC
Other - Org Name:NEUROTECH, LLC FIXED IDTF
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING & RESEARCH
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:WILDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-875-6572
Mailing Address - Street 1:3232 RIDGE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3127
Mailing Address - Country:US
Mailing Address - Phone:708-889-6096
Mailing Address - Fax:
Practice Address - Street 1:1263 MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1341
Practice Address - Country:US
Practice Address - Phone:262-875-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier