Provider Demographics
NPI:1821597485
Name:ADVANCED NEUROLOGY LLC
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:GHIYATH
Authorized Official - Last Name:ALNAHASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-531-6571
Mailing Address - Street 1:206 GLENCOE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7760
Mailing Address - Country:US
Mailing Address - Phone:219-531-6571
Mailing Address - Fax:
Practice Address - Street 1:1551 STURDY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7883
Practice Address - Country:US
Practice Address - Phone:219-531-6571
Practice Address - Fax:219-462-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055878A2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty