# PAIN CENTERS OF WISCONSIN - WAUWATOSA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043579741
- **Authorized official:** VISHAL LAL (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (414) 325-7246

## Contact information

- **Practice address:** 959 N MAYFAIR RD, MILWAUKEE, WI 53226-3465
- **Practice address phone:** (414) 955-7246
- **Practice address fax:** (414) 955-6396
- **Mailing address:** 4131 W LOOMIS RD STE 300, GREENFIELD, WI 53221-2059
- **Mailing address phone:** (414) 325-7246
- **Mailing address fax:** (414) 325-3770

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/15/2012
- **Last updated:** 11/28/2016