Organization
WISCONSIN NEUROLOGY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRENDRA K MISRA MD (OWNER)
(414) 431-6760
Entity
Organization
Contact information
Practice address
2603 W RAWSON AVE, SUITE 128, OAK CREEK, WI 53154-8422
(414) 431-6760
(414) 431-6761
Mailing address
2603 W RAWSON AVE, SUITE 128, OAK CREEK, WI 53154-8422
(414) 431-6760
(414) 431-6761
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
38580
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32336900
—
WI
Enumeration date
07/06/2006
Last updated
10/24/2007
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