Provider Demographics
NPI:1326099391
Name:CHICAGO INSTITUTE OF NEUROSURGERY & NEURORESEARCH
Entity Type:Organization
Organization Name:CHICAGO INSTITUTE OF NEUROSURGERY & NEURORESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OF GROUP
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CERULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-250-0500
Mailing Address - Street 1:4501 N WINCHESTER AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5265
Mailing Address - Country:US
Mailing Address - Phone:773-250-0500
Mailing Address - Fax:773-250-0497
Practice Address - Street 1:4501 N WINCHESTER AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5265
Practice Address - Country:US
Practice Address - Phone:773-250-0500
Practice Address - Fax:773-250-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042005619207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209226Medicare ID - Type UnspecifiedGROUP NUMBER
IL207443Medicare ID - Type UnspecifiedGROUP NUMBER
IL774790Medicare ID - Type UnspecifiedGROUP NUMBER
IL212419Medicare ID - Type UnspecifiedGROUP NUMBER
IL1215510001Medicare NSC