Great Lakes Neurosurgical Associates LLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

Legal business name

GREAT LAKES NEUROSURGICAL ASSOCIATES LLC

Practice address

10400 75TH St
Kenosha, WI 53142-7884

Phone

(262) 948-7000

NPI assigned

Nov 13, 2007

Organization subpart

Yes

Parent organization

GREAT LAKES NEUROSURGICAL ASSOCIATES LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Yashdip S Pannu, M.D.

Title

Owner

Phone

(414) 385-8702

Specialties & licenses 1

Addresses

Part of

Great Lakes Nuro Assoc LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Great Lakes Neurosurgical Associates LLC

  • Neurological Surgery Physician
  • Milwaukee, WI
  • NPI 1134317738
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368748800000",
    "number": "1578743019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 241393",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532249032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 75TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427884",
            "telephone_number": "262-948-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES NEUROSURGICAL ASSOCIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT LAKES NEUROSURGICAL ASSOCIATES LLC",
        "enumeration_date": "2007-11-13",
        "last_updated": "2013-05-17",
        "status": "A",
        "authorized_official_last_name": "PANNU",
        "authorized_official_first_name": "YASHDIP",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-385-8702",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ebonie Gray, RN, APNP, FNP-BC
• Megan Gray, D.D.S.
• Great Lakes Dermatology
• Great Lakes Family Medical Center Inc
• Great Lakes Foot & Ankle Centers Inc
• Great Lakes Surgery Center LLC
• Great Lakes Surgery LLC
• Green Bay Road Medical Services Inc
• Christine Green, PT, ATC
• Thomas Joseph Green III

• Neurological Surgery Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Neurological Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.