Provider Demographics
NPI:1962759415
Name:MIDWEST NEURO FORENSICS, PC
Entity type:Organization
Organization Name:MIDWEST NEURO FORENSICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BONESTEEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-969-3233
Mailing Address - Street 1:2609 METROPOLITAN PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4216
Mailing Address - Country:US
Mailing Address - Phone:586-446-2225
Mailing Address - Fax:586-446-2227
Practice Address - Street 1:2609 METROPOLITAN PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4216
Practice Address - Country:US
Practice Address - Phone:586-446-2225
Practice Address - Fax:586-446-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013025103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty