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Organization
MIND NEUROLOGY WISCONSIN SC
Active
Organization
MIND NEUROLOGY WISCONSIN SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB HART RN BSN MBA (CHIEF OPERATING OFFICER)
(414) 430-0069
Entity
Organization
Contact information
Practice address
12200 CORPORATE PKWY STE 400, MEQUON, WI 53092-3300
(414) 430-0069
Mailing address
12200 CORPORATE PKWY STE 400, MEQUON, WI 53092-3300
(888) 585-7975
(833) 687-1434
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
261QU0200X
Urgent Care Clinic/Center
—
NULL
Other
Enumeration date
06/06/2022
Last updated
08/19/2024
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