Provider Demographics
NPI:1629188701
Name:NORTHWEST BRAIN AND SPINE SURGERY, S.C.
Entity Type:Organization
Organization Name:NORTHWEST BRAIN AND SPINE SURGERY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAFWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-741-1610
Mailing Address - Street 1:1425 N MCLEAN BLVD
Mailing Address - Street 2:STE 550
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5723
Mailing Address - Country:US
Mailing Address - Phone:847-741-1610
Mailing Address - Fax:847-741-1798
Practice Address - Street 1:1425 N MCLEAN BLVD
Practice Address - Street 2:STE 550
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5723
Practice Address - Country:US
Practice Address - Phone:847-741-1610
Practice Address - Fax:847-741-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL246050Medicare ID - Type Unspecified
ILD10212Medicare UPIN