Provider Demographics
NPI:1275867491
Name:AMBULATORY NEUROLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:AMBULATORY NEUROLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:IRIBARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-340-9726
Mailing Address - Street 1:1833 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1557
Mailing Address - Country:US
Mailing Address - Phone:847-340-9726
Mailing Address - Fax:866-858-7255
Practice Address - Street 1:7300 HUDSON BLVD N
Practice Address - Street 2:SUITE 220
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-7141
Practice Address - Country:US
Practice Address - Phone:651-330-1136
Practice Address - Fax:866-858-7255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBULATORY NEUROLOGICAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty