=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689987273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAGANI NEUROLOGICAL INSTITUTE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2010
-----------------------------------------------------
Last Update Date | 10/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2123 AUBURN AVE SUITE 310
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-241-2123
-----------------------------------------------------
Fax | 513-241-0417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2123 AUBURN AVE SUITE 310
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-241-2123
-----------------------------------------------------
Fax | 513-241-0417
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LUIS F PAGANI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 513-241-2123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 17501
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------