MEDICARE: NATHAN ARTHUR LEVENTHAL R.EEGT, CNIM

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	246ZE0500X	EEG Specialist/Technologist	1445	TX
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	546	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1445	OTHER	TX	R-EEG-T
2	546	OTHER	TX	CNIM

General Provider Information

NPI Number	:	1508862087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN ARTHUR LEVENTHAL R.EEGT, CNIM

Provider Business Mailing Address
First Line	:	25 HIGHLAND PARK VLG STE 100-225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-2789
Country	:	US
Telephone Number	:	214-460-2946
Fax Number	:	214-975-1312

Provider Business Practice Location Address
First Line	:	25 HIGHLAND PARK VLG STE 100-225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-2789
Country	:	US
Telephone Number	:	214-460-2946
Fax Number	:	214-975-1312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	10/11/2011

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