MEDICARE: PRECISION NEURODIAGNOSTICS LLC

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	204R00000X	Electrodiagnostic Medicine Physician	036.125813	IL

General Provider Information

NPI Number	:	1437446630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION NEURODIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	401 N MICHIGAN AVE
Second Line	:	SUITE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60611-4255
Country	:	US
Telephone Number	:	816-728-3674
Fax Number	:	312-753-5300

Provider Business Practice Location Address
First Line	:	401 N MICHIGAN AVE
Second Line	:	SUITE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60611-4255
Country	:	US
Telephone Number	:	816-728-3674
Fax Number	:	312-753-5300

Authorized Official
Title or Position	:	CEO
Name	:	DR. AMISH M PATEL
Credential	:	D.O.
Telephone Number	:	816-728-3674

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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