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General NPI Number Information
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NPI Number | 1790875987
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Entity Type | Organization
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Legal Business Name | S I NEUROLOGY & SLEEP MEDICINE LLC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 2731 WEST MAIN STREET SUITE A
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City | CARBONDALE
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State | IL
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Zip | 62901
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Country | US
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Telephone | 618-549-6378
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Fax | 618-529-2347
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | CARBONDALE
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State | IL
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Zip | 62903-0489
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Country | US
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Telephone | 618-549-6378
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Fax | 618-529-2347
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Authorized Official
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Title or Position | MD
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Name | FAKHRE ALAM
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Credential | MD
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Telephone | 618-549-6378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036101704
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License Number State | IL
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