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General NPI Number Information
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NPI Number | 1679654743
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Entity Type | Organization
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Legal Business Name | CNS NEUROLOGICAL SURGERY SC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3825 HIGHLAND AVE TOWER 1, SUITE 5M
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1552
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Country | US
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Telephone | 630-725-9890
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Fax | 630-725-0988
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Provider Business Mailing Address
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Address Line | PAYSPHERE CIR DEPT 9029
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City | CHICAGO
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State | IL
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Zip | 60674
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Country | US
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Telephone | 630-725-9890
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Fax | 630-725-0988
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STAVROS NICHOLAS MALTEZOS
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Credential | M.D.
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Telephone | 630-725-9890
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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 | IL
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