Provider Demographics
NPI:1992940407
Name:MIDWEST NEUROSURGEONS LLC
Entity type:Organization
Organization Name:MIDWEST NEUROSURGEONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONJAY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FONN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-651-1687
Mailing Address - Street 1:65 DOCTORS PARK STE A
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4927
Mailing Address - Country:US
Mailing Address - Phone:573-651-1687
Mailing Address - Fax:573-651-8734
Practice Address - Street 1:65 DOCTORS PARK STE A
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4927
Practice Address - Country:US
Practice Address - Phone:573-651-1687
Practice Address - Fax:573-651-8734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6202790001Medicare NSC