1386850782 NPI number — SANDRA KORTHAS

Table of content: SANDRA KORTHAS (NPI 1386850782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386850782 NPI number — SANDRA KORTHAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORTHAS
Provider First Name:
SANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386850782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 FARINGDON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUKESHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53188-1343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-547-5973
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTER FOR BLIND & VISUALLY IMPAIRED CHILDREN
Provider Second Line Business Practice Location Address:
5600 W BROWN DEER RD, STE. 4
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-355-3060
Provider Business Practice Location Address Fax Number:
414-355-3547
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42692900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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