Provider Demographics
NPI:1922182500
Name:SURGICAL NEUROLOGY ASSOC LTD
Entity Type:Organization
Organization Name:SURGICAL NEUROLOGY ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-398-6464
Mailing Address - Street 1:880 W CENTRAL RD
Mailing Address - Street 2:SUITE 6100
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2355
Mailing Address - Country:US
Mailing Address - Phone:847-398-6464
Mailing Address - Fax:847-398-7961
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 6100
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-398-6464
Practice Address - Fax:847-398-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42002512207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615968OtherBCBS IL
IL1615968OtherBCBS IL