Provider Demographics
NPI:1992902969
Name:NEUROSURGERY CONSULTANTS SC
Entity type:Organization
Organization Name:NEUROSURGERY CONSULTANTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:UDEHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-764-3993
Mailing Address - Street 1:4350 7TH ST
Mailing Address - Street 2:UNIT E
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6870
Mailing Address - Country:US
Mailing Address - Phone:309-764-3993
Mailing Address - Fax:309-764-4292
Practice Address - Street 1:4350 7TH ST
Practice Address - Street 2:UNIT E
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6870
Practice Address - Country:US
Practice Address - Phone:309-764-3993
Practice Address - Fax:309-764-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08132080OtherBLUE CROSS BLUE SHIELD
ILC46196Medicare UPIN
IL212012Medicare ID - Type Unspecified