GREAT LAKES NEUROSURGICAL ASSOCIATES LLC (NPI# 1457531899) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457531899 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES NEUROSURGICAL ASSOCIATES LLC |
| Practice Address |
8400 Washington Ave Racine WI 53406-3735 |
| Mailing Address |
Po Box 241393 Milwaukee WI 53224-9032 |
| Practice Telephone | 2628844000 |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2013-05-17 |
| Authorized Official Name | DR. YASHDIP S PANNU (OWNER) |
| Authorized Official Telephone | 2623213000 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | GREAT LAKES NEUROSURGICAL ASSOCIATES LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578743019 | Great Lakes Neurosurgical Associates LLC | Neurological Surgery | 10400 75th St, Kenosha, WI 53142-7884 | 2007-11-13 |
| 1134317738 | Great Lakes Neurosurgical Associates LLC | Neurological Surgery | 2901 W Kinnickinnic River Parkway, Suite 300, Milwaukee, WI 53215 | 2007-10-09 |
| Street Address |
8400 WASHINGTON AVE |
| City | RACINE |
| State | WI |
| Zip Code | 53406-3735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366651796 | Aurora Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 8400 Washington Ave, Racine, WI 53406-3735 | 2007-05-22 |
| 1417064742 | Anthony J Park | Obstetrics & Gynecology | 8400 Washington Ave, Racine, WI 53406 | 2006-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164349 | Lynn Huynh | Pharmacist | 5695 Washington Ave, Racine, WI 53406 | 2020-11-06 |
| 1659920049 | Carol Jean Cornejo | Technician | 6528 Heritage Avenue, Mt Pleasant, WI 53406 | 2019-09-09 |
| 1265913958 | Mary Goldbeck | Social Worker | 1775 Newman Rd, Mt Pleasant, WI 53406 | 2018-08-22 |
| 1669963344 | Kelly Nicole Nelson | Registered Nurse | 8800 Washington Ave Ste 200, Mount Pleasant, WI 53406 | 2018-05-29 |
| 1891212163 | Ilona Agata Pryomski | Nurse Practitioner | 9201 Washington Ave, Racine, WI 53406 | 2017-08-27 |
| 1386185106 | Margaret M. Abaogye Dds | Dentist | 4340 Newman Rd., Racine, WI 53406 | 2017-03-13 |
| 1508309212 | Rebecca Koeppen | Dietitian, Registered | 8400 Washington Ave., Racine, WI 53406 | 2016-11-29 |
| 1386194371 | Forefront Dermatology, S.c. | Dermatology | 7200 Washington Ave, Suite 100, Mount Pleasant, WI 53406 | 2016-10-13 |
| 1356891402 | Forefront Dermatology, S.c. | Dermatology | 1515 S Green Bay Rd, Racine, WI 53406 | 2016-10-12 |
| 1861841470 | Leah Marie Johnson | Dentist | 1101 South Airline Road, Racine, WI 53406 | 2016-06-06 |
| Find all providers in zip 53406 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679672430 | S. Marshall Cushman | Neurological Surgery | 3805b Spring St Ste 320, Racine, WI 53405-1644 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528350436 | Craig R Kelman | Neurological Surgery | 425 Pine Ridge Blvd Ste 300, Wausau, WI 54401 | 2011-05-11 |
| 1952545014 | Irene Kim | Neurological Surgery | 999 N 92nd St Ste 310, Milwaukee, WI 53226-4875 | 2009-04-20 |
| 1649419169 | Walter P Jacobsen | Neurological Surgery | 2801 W Kinnickinnic River Pkwy Ste 680, Milwaukee, WI 53215-3669 | 2009-02-05 |
| 1538324793 | Jose Luis Salazar | Neurological Surgery | 3220 N Shore Dr, Delavan, WI 53115-3800 | 2008-07-26 |
| 1205094711 | Bruce Clarke Bressler | Neurological Surgery | 3117 Bay View Dr, Green Bay, WI 54311-5909 | 2008-05-30 |
| 1154506921 | Werner E Langheim | Neurological Surgery | 4505 Fox Bluff Lane, Middleton, WI 53562-2327 | 2007-12-29 |
| 1427251339 | Pedro Daniel Suberviola | Neurological Surgery | 3255 Yale Ct, Brookfield, WI 53005-2772 | 2007-06-07 |
| 1831212778 | Allan Bertram Levin | Neurological Surgery | 4585 Fox Bluff Ln, Middleton, WI 53562-2327 | 2007-04-07 |
| 1013093178 | Cully R White | Neurological Surgery | 2901 W Kinnickinnic River Parkway, Suite 201, Milwaukee, WI 53215 | 2006-10-31 |
| 1538269402 | Christopher I. Mackay | Neurological Surgery | 2800 Westhill Dr., Suite 200, Wausau, WI 54407-3770 | 2006-09-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.