Provider Demographics
NPI:1932191939
Name:NORTH SUBURBAN NEUROSURGERY PC
Entity Type:Organization
Organization Name:NORTH SUBURBAN NEUROSURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-9394
Mailing Address - Street 1:9700 KENTON AVE
Mailing Address - Street 2:K401
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1259
Mailing Address - Country:US
Mailing Address - Phone:847-674-9394
Mailing Address - Fax:847-674-9791
Practice Address - Street 1:9700 KENTON AVE
Practice Address - Street 2:K401
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1259
Practice Address - Country:US
Practice Address - Phone:847-674-9394
Practice Address - Fax:847-674-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL459260Medicare PIN