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General NPI Number Information
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NPI Number | 1801339858
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Entity Type | Organization
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Legal Business Name | ADVANCED NEUROSCIENCE INNOVATION INSTITUTE LLC
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 5666 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61108-2425
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Country | US
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Telephone | 815-395-5261
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Fax | 815-381-7581
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Provider Business Mailing Address
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Address Line | PO BOX 639
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City | THIENSVILLE
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State | WI
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Zip | 53092-0639
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Country | US
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Telephone | 414-247-9005
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Fax | 414-247-9004
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | AKRAM SHHADEH
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Credential | MD
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Telephone | 973-901-5457
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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 | 036141087
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License Number State | IL
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