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General NPI Number Information
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NPI Number | 1033875125
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Entity Type | Organization
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Legal Business Name | CHICAGO NEUROSPINE SURGERY PLLC
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 19110 DARVIN DR STE C
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City | MOKENA
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State | IL
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Zip | 60448-8683
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Country | US
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Telephone | 708-765-3999
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Fax | 708-765-3939
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Provider Business Mailing Address
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Address Line | 19110 DARVIN DR STE C
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City | MOKENA
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State | IL
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Zip | 60448-8683
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Country | US
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Telephone | 708-765-3999
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Fax | 708-765-3939
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MILLY CASTILLO
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Credential |
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Telephone | 708-765-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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