Provider Demographics
NPI:1679654743
Name:CNS NEUROLOGICAL SURGERY SC
Entity Type:Organization
Organization Name:CNS NEUROLOGICAL SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAVROS
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MALTEZOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-725-9890
Mailing Address - Street 1:PAYSPHERE CIR DEPT 9029
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:630-725-9890
Mailing Address - Fax:630-725-0988
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:TOWER 1, SUITE 5M
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-725-9890
Practice Address - Fax:630-725-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
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
IL0001617783OtherBLUE SHIELD
IL996400Medicare ID - Type UnspecifiedMEDICARE