BLACKHAWK IOM, LLC (NPI# 1922515477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922515477 |
| Entity Type | Organization |
| Organization Name | BLACKHAWK IOM, LLC |
| Practice Address |
1314 S 1st St # 308 Milwaukee WI 53204-2405 |
| Practice Telephone | 4143696544 |
| Mailing Telephone | 4143696544 |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2018-01-05 |
| Authorized Official Name | LIZETTE MORIN (MDMS NPI COMPLIANCE OFFICER) |
| Authorized Official Telephone | 2105982800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204R00000X | Electrodiagnostic Medicine | Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 246ZE0600X |
Specialist/Technologist, Other Specialization: Electroneurodiagnostic |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
Allopathic & Osteopathic Physicians |
| Street Address |
1314 S 1ST ST # 308 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53204-2405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528423290 | Blue Ribbon Healthcare LLC | Health Maintenance Organization | 1743 South1st Street, Milwaukee, WI 53204 | 2015-12-23 |
| 1215336599 | Marsha Vann | Counselor | 1028 N 9th St, Milwaukee, WI 53204 | 2014-08-22 |
| 1891109260 | Melissa Bendever | Counselor | 1111 South 6th Street, Milwaukee, WI 53204 | 2014-06-13 |
| 1942585823 | Theresa Marie Hintze | Counselor | 600 W Virginia Atlas Ste 203, Milwaukee, WI 53204 | 2011-10-11 |
| 1922395151 | Palmas & Ram Rudra LLC | Chiropractor | 1247 S. Cesar E. Chaves Drive, Milwaukee, WI 53204 | 2011-07-08 |
| 1225355183 | Victoria A White | Family Medicine | 16th Street Community Health Center, 1032 S Cesar E. Chavez Drive, Milwaukee, WI 53204 | 2010-04-30 |
| 1174850499 | Dnt Associates Inc. | Dentist | 710 W. Historic Mitchell St., Mitchell Street Dental, Milwaukee, WI 53204 | 2009-11-06 |
| 1851559124 | Michael L Kitzinger | Social Worker | 1201 W Historic Mitchell St, Milwaukee, WI 53204 | 2008-05-23 |
| 1083778781 | Douglas Ralph Higbie | Psychologist | 634 W Mitchell St, Milwaukee, WI 53204 | 2006-12-20 |
| 1013019413 | Romeo C Lo Md | Internal Medicine | 1672 S 9th St, 2nd Floor, Milwaukee, WI 53204 | 2006-09-05 |
| Find all providers in zip 53204 | ||||
| Taxonomy Code | 2084N0600X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Clinical Neurophysiology |
| Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS). |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659511780 | Center for Neurology & Sleep Disorders, Sc | Psychiatry & Neurology | 240 Regency Ct, Suite 201, Brookfield, WI 53045-6162 | 2009-03-03 |
| 1285802413 | Insight Neuralmonitoring, Inc. | Psychiatry & Neurology | N17w24222 Riverwood Dr, Suite 190, Waukesha, WI 53188-1132 | 2008-02-11 |
| 1508878422 | Rakesh J Shah | Psychiatry & Neurology | 190 Gardner Ave, Suite 3, Burlington, WI 53105-2160 | 2006-08-12 |
| 1770886392 | Vigilant Partners, S.c. | Psychiatry & Neurology | 318 Park Dr, Neenah, WI 54956-2899 | 2010-12-21 |
| 1194963504 | Neurology Alliance S.c. | Psychiatry & Neurology | 2424 S 90th St, Suite 504, West Allis, WI 53227-2455 | 2009-01-23 |
| 1508939976 | John Scott Broderick | Psychiatry & Neurology | 13133 N Port Washington Rd, Suite G06, Mequon, WI 53097-2419 | 2006-11-15 |
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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.