Basic Information
| Provider Information | |||||||||
| NPI: | 1528734902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TMS CLINICAL SERVICES OF WISCONSIN SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 JORIE BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605232219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309746602 | ||||||||
| FaxNumber: | 6304872411 | ||||||||
| Practice Location | |||||||||
| Address1: | 2448 S 102ND ST STE 180 | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532272466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309746602 | ||||||||
| FaxNumber: | 6304872411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2021 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | POPRAWSKI | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6309746602 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.