Provider Demographics
NPI:1982803102
Name:NEUROLOGY AND PAIN TREATMENT, LTD.
Entity Type:Organization
Organization Name:NEUROLOGY AND PAIN TREATMENT, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-453-7780
Mailing Address - Street 1:2600 N MAYFAIR RD STE 1120
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1308
Mailing Address - Country:US
Mailing Address - Phone:414-453-7780
Mailing Address - Fax:
Practice Address - Street 1:2600 N MAYFAIR RD STE 1120
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1308
Practice Address - Country:US
Practice Address - Phone:414-453-7780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI198412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30033300Medicaid
WI30033300Medicaid
WI30033300Medicaid