Provider Demographics
NPI:1740209972
Name:ADVANCED NEURO DIAGNOSTICS LTD
Entity Type:Organization
Organization Name:ADVANCED NEURO DIAGNOSTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER.PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-676-0547
Mailing Address - Street 1:350 E DUNDEE RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3192
Mailing Address - Country:US
Mailing Address - Phone:224-676-0547
Mailing Address - Fax:224-676-0564
Practice Address - Street 1:350 E DUNDEE RD
Practice Address - Street 2:SUITE 315
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3192
Practice Address - Country:US
Practice Address - Phone:224-676-0547
Practice Address - Fax:224-676-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36391682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE14548Medicare UPIN
IL202073Medicare ID - Type Unspecified