Provider Demographics
NPI:1144327792
Name:NEUROLOGY CENTER OF KENOSHA, S.C.
Entity type:Organization
Organization Name:NEUROLOGY CENTER OF KENOSHA, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:262-656-8888
Mailing Address - Street 1:704 55TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3732
Mailing Address - Country:US
Mailing Address - Phone:262-656-8888
Mailing Address - Fax:262-656-8892
Practice Address - Street 1:704 55TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3732
Practice Address - Country:US
Practice Address - Phone:262-656-8888
Practice Address - Fax:262-656-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI290162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31381100Medicaid
WI0500018OtherUNITEDHEALTHCARE
WI31381100Medicaid
WI=========011OtherBLUE CROSS BLUE SHIELD
WI31381100Medicaid