Provider Demographics
NPI:1063618973
Name:MIDWEST NEUROLODIAGNOSTIC SPECIALISTS
Entity type:Organization
Organization Name:MIDWEST NEUROLODIAGNOSTIC SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALWAJI
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:773-522-3926
Mailing Address - Street 1:3358 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4037
Mailing Address - Country:US
Mailing Address - Phone:773-522-3926
Mailing Address - Fax:773-522-1343
Practice Address - Street 1:3358 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4037
Practice Address - Country:US
Practice Address - Phone:773-522-3926
Practice Address - Fax:773-522-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4121012111NN0400X
IL111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty