Individual
VIRENDRA K MISRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2603 W RAWSON AVE, SUITE 128, OAK CREEK, WI 53154-8422
(414) 431-6760
(414) 431-6761
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 247-9005
(414) 247-9004
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
38580
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001093
MEDICARE PTAN
WI
05
—
32336900
—
WI
Enumeration date
04/13/2006
Last updated
05/20/2015
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