Basic Information
| Provider Information | |||||||||
| NPI: | 1326099391 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHICAGO INSTITUTE OF NEUROSURGERY & NEURORESEARCH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4501 N WINCHESTER AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606405265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732500500 | ||||||||
| FaxNumber: | 7732500497 | ||||||||
| Practice Location | |||||||||
| Address1: | 4501 N WINCHESTER AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606405265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732500500 | ||||||||
| FaxNumber: | 7732500497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | CERULLO | ||||||||
| AuthorizedOfficialFirstName: | LEONARD | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR OF GROUP | ||||||||
| AuthorizedOfficialTelephone: | 7732500500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 042005619 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.