Provider Demographics
NPI:1790875987
Name:S I NEUROLOGY & SLEEP MEDICINE LLC
Entity Type:Organization
Organization Name:S I NEUROLOGY & SLEEP MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FAKHRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-549-6378
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-0489
Mailing Address - Country:US
Mailing Address - Phone:618-549-6378
Mailing Address - Fax:618-529-2347
Practice Address - Street 1:2731 WEST MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-549-6378
Practice Address - Fax:618-529-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361017042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101704Medicaid
K12922Medicare PIN
DC6798Medicare PIN
IL036101704Medicaid
210516Medicare PIN