Provider Demographics
NPI:1760759088
Name:B-T NEURODIAGNOSTICS LTD
Entity Type:Organization
Organization Name:B-T NEURODIAGNOSTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-439-2121
Mailing Address - Street 1:2430 PLAINFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-1467
Mailing Address - Country:US
Mailing Address - Phone:815-439-2121
Mailing Address - Fax:815-439-8415
Practice Address - Street 1:2430 PLAINFIELD ROAD
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-1467
Practice Address - Country:US
Practice Address - Phone:815-439-2121
Practice Address - Fax:815-439-8415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076533208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF36305Medicare UPIN
IL203778Medicare PIN