Wisconsin Neurology Clinic, LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

38580 Issued in WI

Legal business name

WISCONSIN NEUROLOGY CLINIC, LLC

Practice address

2603 W Rawson Ave
Suite 128
Oak Creek, WI 53154-8422

Phone

(414) 431-6760

Fax

(414) 431-6761

NPI assigned

Jul 6, 2006

Last updated

Oct 24, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Virendra K Misra, MDNPI 1780648048

Title

Owner

Phone

(414) 431-6760

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Virendra K Misra, MD

  • Neurology Physician
  • Oak Creek, WI
  • NPI 1780648048
  Authorized official Same address or phone

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1639101405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 W RAWSON AVE",
            "address_2": "SUITE 128",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548422",
            "telephone_number": "414-431-6760",
            "fax_number": "414-431-6761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 W RAWSON AVE",
            "address_2": "SUITE 128",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548422",
            "telephone_number": "414-431-6760",
            "fax_number": "414-431-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN NEUROLOGY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "MISRA",
        "authorized_official_first_name": "VIRENDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-431-6760",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "38580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32336900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deana L S Wilson, PSYD
• Tammy Ann Wilson, RN
• Wisconsin CVS Pharmacy LLC (CVS Pharmacy #17043)
• Wisconsin Dental Group, S.C. (ForwardDental Oak Creek)
• Wisconsin Lutheran Child & Family Service, Inc (Christian Family Counseling)
• Wisconsin Oral & Maxillofacial Surgery LLC (White Oak Dental)
• Wisconsin Orthotics & Prosthetics Center LLC
• Stephanie Lynn Witt
• Catherine Ann Woehlck, LPC
• Lisa Wolf, MD

• Neurology Physician in Oak Creek, WI
• Providers in Oak Creek, WI by specialty
• Neurology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; 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.