Organization
THE NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN SC
Active
Organization
THE NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN SC
Active
Other names
Neuroscience Group
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP YAZBAK MD (PRESIDENT)
(800) 201-1194
Entity
Organization
Contact information
Practice address
1305 W. AMERICAN DRIVE, NEENAH, WI 54956-1993
(800) 201-1194
(920) 720-7392
Mailing address
1305 W AMERICAN DRIVE, NEENAH, WI 54956-1993
(800) 201-1194
(920) 720-7392
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000071450
MEDICARE
WI
05
—
21284100
—
WI
01
—
CD3987
RAILROAD MEDICARE
—
Enumeration date
05/18/2006
Last updated
08/16/2019
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