Provider Demographics
NPI:1063635126
Name:INSTITUTE OF NEUROLOGICAL SURGERY
Entity Type:Organization
Organization Name:INSTITUTE OF NEUROLOGICAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:SHAHRAM
Authorized Official - Last Name:MAKOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-498-1608
Mailing Address - Street 1:615 W AVENUE Q
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3887
Mailing Address - Country:US
Mailing Address - Phone:661-266-4500
Mailing Address - Fax:661-266-4502
Practice Address - Street 1:615 W AVENUE Q
Practice Address - Street 2:SUITE D
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3887
Practice Address - Country:US
Practice Address - Phone:661-266-4500
Practice Address - Fax:661-266-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207T00000X
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6035440001Medicare NSC
CAW20643Medicare PIN