Provider Demographics
NPI:1861865867
Name:ADVANCED HEADACHE AND NEUROCARE CLINIC
Entity Type:Organization
Organization Name:ADVANCED HEADACHE AND NEUROCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-697-7907
Mailing Address - Street 1:73 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1242
Mailing Address - Country:US
Mailing Address - Phone:630-697-7907
Mailing Address - Fax:
Practice Address - Street 1:4945 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3509
Practice Address - Country:US
Practice Address - Phone:630-697-7907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115294261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty