Provider Demographics
NPI:1316973977
Name:CENTER FOR NEUROLOGICAL DISEASES S.C
Entity type:Organization
Organization Name:CENTER FOR NEUROLOGICAL DISEASES S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEDAVYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:815-741-9719
Mailing Address - Street 1:2222 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0928
Mailing Address - Country:US
Mailing Address - Phone:815-741-9719
Mailing Address - Fax:815-744-5137
Practice Address - Street 1:2222 WEBER RD
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0928
Practice Address - Country:US
Practice Address - Phone:815-741-9719
Practice Address - Fax:815-744-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097009207T00000X
IL036115848207T00000X
IL036083980207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI55486Medicare UPIN
ILK28845Medicare PIN
IL213811Medicare PIN
ILF84986Medicare UPIN
ILK28773Medicare PIN
ILG59947Medicare UPIN
ILK34797Medicare PIN