MEDICARE: CENTER FOR NEUROLOGICAL DISEASES S.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	036115848	IL
2	207T00000X	Neurological Surgery Physician	036083980	IL
3	207T00000X	Neurological Surgery Physician	036097009	IL

General Provider Information

NPI Number	:	1316973977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR NEUROLOGICAL DISEASES S.C

Provider Business Mailing Address
First Line	:	2222 WEBER RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-0928
Country	:	US
Telephone Number	:	815-741-9719
Fax Number	:	815-744-5137

Provider Business Practice Location Address
First Line	:	2222 WEBER RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-0928
Country	:	US
Telephone Number	:	815-741-9719
Fax Number	:	815-744-5137

Authorized Official
Title or Position	:	MANAGER
Name	:	RAKESH VEDAVYAS
Credential	:	MR
Telephone Number	:	815-741-9719

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	10/22/2012

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