GREAT LAKES NEUROSURGICAL ASSOCIATES LLC (NPI# 1578743019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578743019 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES NEUROSURGICAL ASSOCIATES LLC |
| Practice Address |
10400 75th St Kenosha WI 53142-7884 |
| Mailing Address |
Po Box 241393 Milwaukee WI 53224-9032 |
| Practice Telephone | 2629487000 |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2013-05-17 |
| Authorized Official Name | DR. YASHDIP S PANNU (OWNER) |
| Authorized Official Telephone | 4143858702 |
| 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 |
|---|---|---|---|---|
| 1457531899 | Great Lakes Neurosurgical Associates LLC | Neurological Surgery | 8400 Washington Ave, Racine, WI 53406-3735 | 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 |
10400 75TH ST |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-7884 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477546737 | Mea-aea Kenosha Sc | Family Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2005-08-23 |
| 1548877707 | Megan Labine | Dietitian, Registered | 10400 75th St, Kenosha, WI 53142-7884 | 2020-09-30 |
| 1730796574 | Saralyn Paredes | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-7884 | 2020-09-25 |
| 1518586965 | Ariel Adelsen | Registered Nurse | 10400 75th St, Kenosha, WI 53142-7884 | 2020-04-15 |
| 1134757073 | Amber Jirschele | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-8323 | 2020-03-27 |
| 1912539974 | Kristina A Roscizewski | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-7884 | 2020-02-07 |
| 1386274413 | Ethan Nathaniel Mcfaddin | Pharmacist | 10400 75th St, Kenosha, WI 53142-7884 | 2020-01-16 |
| 1972133031 | Patricia Grzyb | Physician Assistant | 10400 75th St, Kenosha, WI 53142-7884 | 2020-01-16 |
| 1144873654 | Lauren Cornejo | Occupational Therapist | 10400 75th St, Kenosha, WI 53142-8323 | 2019-07-23 |
| 1245710771 | Brenda Joyce Woodhull | Registered Nurse | 10400 75th St, Kenosha, WI 53142-7884 | 2018-08-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| 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 |
|---|---|---|---|---|
| 1558404236 | Ofer M Zikel | Neurological Surgery | 10400 75th St, Kenosha, WI 53142-7884 | 2007-02-14 |
| 1326113309 | Goro Tsuchiya Md Sc | Neurological Surgery | 3535 30th Avenue, Suite 205, Kenosha, WI 53144-1632 | 2006-11-22 |
| 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 |
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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.