Provider Demographics
NPI:1821152778
Name:BRAIN MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:BRAIN MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HIEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-981-9700
Mailing Address - Street 1:2070 N RAND RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2595
Mailing Address - Country:US
Mailing Address - Phone:847-981-9700
Mailing Address - Fax:847-550-0434
Practice Address - Street 1:2070 N RAND RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2595
Practice Address - Country:US
Practice Address - Phone:847-981-9700
Practice Address - Fax:847-550-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360673912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2215709OtherBCBS