Provider Demographics
NPI:1609016211
Name:MIDWEST NEUROSURGERY, P.C.
Entity Type:Organization
Organization Name:MIDWEST NEUROSURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-238-4467
Mailing Address - Street 1:1530 N. 7TH STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807
Mailing Address - Country:US
Mailing Address - Phone:812-238-4467
Mailing Address - Fax:812-238-4469
Practice Address - Street 1:1530 N. 7TH STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807
Practice Address - Country:US
Practice Address - Phone:812-238-4467
Practice Address - Fax:812-238-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042238A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF80803Medicare UPIN