Provider Demographics
NPI:1790236362
Name:CENTER FOR NEUROLOGICAL DISEASES
Entity Type:Organization
Organization Name:CENTER FOR NEUROLOGICAL DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NADKARNI
Authorized Official - Middle Name:
Authorized Official - Last Name:NITIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-9719
Mailing Address - Street 1:2222 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2222 WEBER RD
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0928
Practice Address - Country:US
Practice Address - Phone:815-741-9719
Practice Address - Fax:815-744-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty