Healthcare Provider Details

I. General information

NPI: 1750643524
Provider Name (Legal Business Name): NEUROLOGY AND SLEEP MEDICINE CONSULTANTS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HIGH ST STE B
DECATUR IN
46733-2351
US

IV. Provider business mailing address

815 HIGH ST STE B
DECATUR IN
46733-2351
US

V. Phone/Fax

Practice location:
  • Phone: 260-446-6925
  • Fax:
Mailing address:
  • Phone: 260-446-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01062967A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number01062967A
License Number StateIN

VIII. Authorized Official

Name: YU LIU
Title or Position: OWNER/PROVIDER
Credential:
Phone: 260-446-6925