Provider Demographics
NPI:1598890402
Name:UNIVERSITY NEUROSURGERY AT LUTHERAN
Entity Type:Organization
Organization Name:UNIVERSITY NEUROSURGERY AT LUTHERAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-6644
Mailing Address - Street 1:9301 GOLF RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1667
Mailing Address - Country:US
Mailing Address - Phone:312-942-6644
Mailing Address - Fax:312-942-2176
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:SUITE 206
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:312-942-6644
Practice Address - Fax:312-942-2176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH UNIVERSITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01637091OtherBC GROUP
IL01637091OtherBC GROUP