Healthcare Provider Details

I. General information

NPI: 1821597485
Provider Name (Legal Business Name): ADVANCED NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 STURDY RD
VALPARAISO IN
46383-7883
US

IV. Provider business mailing address

206 GLENCOE DR
VALPARAISO IN
46385-7760
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-6571
  • Fax: 219-462-0765
Mailing address:
  • Phone: 219-531-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01055878A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number01055878A
License Number StateIN

VIII. Authorized Official

Name: DR. MAHMOOD GHIYATH ALNAHASS
Title or Position: PRESIDENT
Credential: MD
Phone: 219-531-6571