Organization
NEUROTECH, LLC
Active
Parent organization
NEUROTECH, LLC
Other names
Neurotech Indiana
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEUROTECH, LLC
Authorized official
KRISTINE LISA WILDNER (DIRECTOR OF CONTRACTING & RESEARCH)
(262) 875-6572
Entity
Organization
Contact information
Practice address
941 E 86TH ST STE 107, INDIANAPOLIS, IN 46240-1842
(262) 875-6611
Mailing address
626 W MORELAND BLVD, WAUKESHA, WI 53188-2433
(262) 754-0898
Taxonomy
Speciality
Code
Description
License number
State
2472E0500X
EEG Technician
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
—
293D00000X
Physiological Laboratory
Primary
—
—
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201132380A
—
IN
Enumeration date
06/17/2014
Last updated
04/23/2021
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