Provider Demographics
NPI:1982122354
Name:CONCERTO WISCONSIN LLC
Entity Type:Organization
Organization Name:CONCERTO WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-233-1202
Mailing Address - Street 1:4600 W TOUHY AVE
Mailing Address - Street 2:#100
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:847-233-1202
Mailing Address - Fax:847-233-1302
Practice Address - Street 1:13905 W BURLEIGH RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3036
Practice Address - Country:US
Practice Address - Phone:262-325-7724
Practice Address - Fax:847-443-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment