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
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
06/06/2022
Last updated
08/19/2024
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