1053483230 NPI number — NEURODIAGNOSTIC CONSULTANTS, LLC.

Table of content: (NPI 1053483230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053483230 NPI number — NEURODIAGNOSTIC CONSULTANTS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEURODIAGNOSTIC CONSULTANTS, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053483230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4453 W HUTCHINSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60641-1993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-497-1467
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
395 E DUNDEE RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60090-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-497-1467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRUSIL
Authorized Official First Name:
OLGA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
312-497-1467

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084N0600X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730275223 . This is a "OLGA O. BRUSIL, MD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".