Provider Demographics
NPI:1053483230
Name:NEURODIAGNOSTIC CONSULTANTS, LLC.
Entity Type:Organization
Organization Name:NEURODIAGNOSTIC CONSULTANTS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:O
Authorized Official - Last Name:BRUSIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-497-1467
Mailing Address - Street 1:4453 W HUTCHINSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1993
Mailing Address - Country:US
Mailing Address - Phone:312-497-1467
Mailing Address - Fax:
Practice Address - Street 1:395 E DUNDEE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-7001
Practice Address - Country:US
Practice Address - Phone:312-497-1467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1730275223OtherOLGA O. BRUSIL, MD