Provider Demographics
NPI:1821498718
Name:NEURO OVERSIGHT LLC
Entity Type:Organization
Organization Name:NEURO OVERSIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOBNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-799-6900
Mailing Address - Street 1:2024 HICKORY RD
Mailing Address - Street 2:STE 301
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2024 HICKORY RD
Practice Address - Street 2:STE 301
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2125
Practice Address - Country:US
Practice Address - Phone:708-799-6900
Practice Address - Fax:708-799-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.065969207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty