Provider Demographics
NPI:1841356714
Name:NEURO ENHANCED IMAGING LLC
Entity type:Organization
Organization Name:NEURO ENHANCED IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VARUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-554-8525
Mailing Address - Street 1:5439 DURAND AVE
Mailing Address - Street 2:STE 215
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5058
Mailing Address - Country:US
Mailing Address - Phone:262-554-8525
Mailing Address - Fax:262-554-8524
Practice Address - Street 1:7523 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-2861
Practice Address - Country:US
Practice Address - Phone:262-554-8525
Practice Address - Fax:262-554-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherTIN NUMBER