Provider Demographics
NPI:1205200383
Name:CHILD NEUROLOGY SOLUTIONS PLLC
Entity Type:Organization
Organization Name:CHILD NEUROLOGY SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-356-0136
Mailing Address - Street 1:360 SHERMAN ST
Mailing Address - Street 2:SUITE 399, FORT ROAD MEDICAL CENTER
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2564
Mailing Address - Country:US
Mailing Address - Phone:651-356-0136
Mailing Address - Fax:
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 399, FORT ROAD MEDICAL CENTER
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-356-0136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN428852084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE71853Medicare UPIN