Healthcare Provider Details

I. General information

NPI: 1942281126
Provider Name (Legal Business Name): AMERICAN CENTER FOR SPINE & NEUROSURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/21/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3225
US

IV. Provider business mailing address

716 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3225
US

V. Phone/Fax

Practice location:
  • Phone: 847-362-1848
  • Fax: 847-362-3351
Mailing address:
  • Phone: 847-362-1848
  • Fax: 847-362-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JONATHAN S CITOW
Title or Position: OWNER
Credential:
Phone: 847-362-1848