Provider Demographics
NPI:1871065227
Name:DR. KATE'S BRAIN EXPEDITION FOR EXCELLENCE
Entity type:Organization
Organization Name:DR. KATE'S BRAIN EXPEDITION FOR EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HABANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-408-9201
Mailing Address - Street 1:N112W16076 MEQUON RD STE A2
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3333
Mailing Address - Country:US
Mailing Address - Phone:262-293-9098
Mailing Address - Fax:
Practice Address - Street 1:N112W16076 MEQUON RD STE A2
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3333
Practice Address - Country:US
Practice Address - Phone:262-293-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1659840353OtherNPPES