Provider Demographics
NPI:1033875125
Name:CHICAGO NEUROSPINE SURGERY PLLC
Entity Type:Organization
Organization Name:CHICAGO NEUROSPINE SURGERY PLLC
Other - Org Name:CHICAGO NEUROSPINE SURGERY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-765-3999
Mailing Address - Street 1:19110 DARVIN DR STE C
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8683
Mailing Address - Country:US
Mailing Address - Phone:708-765-3999
Mailing Address - Fax:708-765-3939
Practice Address - Street 1:19110 DARVIN DR STE C
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8683
Practice Address - Country:US
Practice Address - Phone:708-765-3999
Practice Address - Fax:708-765-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty