| NPI | 1649008004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER BLANK Contracting & Credentialing Manager 262-875-6575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology |
| Enumeration Date | 2024-07-25 |
| Last Update Date | 2024-07-25 |