Organization
GREAT LAKES NEUROSURGICAL ASSOCIATES LLC
Active
Parent organization
GREAT LAKES NEUROSURGICAL ASSOCIATES LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LAKES NEUROSURGICAL ASSOCIATES LLC
Authorized official
DR. YASHDIP S PANNU M.D. (OWNER)
(414) 385-8702
Entity
Organization
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-7000
Mailing address
PO BOX 241393, MILWAUKEE, WI 53224-9032
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Enumeration date
11/13/2007
Last updated
05/17/2013
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