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NPI Code Detail

MEDICARE: DEFINITIVE NEURODIAGNOSTICS LLC

MEDICARE: DEFINITIVE 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
1246ZE0600XElectroneurodiagnostic Specialist/Technologist036100906IL

General Provider Information

NPI Number : 1659490761
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEFINITIVE NEURODIAGNOSTICS LLC
Provider Business Mailing Address
First Line : 1604 VISA DR
Second Line : SUITE 1
City : NORMAL
State : IL
Zip : 61761-2195
Country : US
Telephone Number : 309-454-1100
Fax Number : 309-454-1107
Provider Business Practice Location Address
First Line : 1604 VISA DR
Second Line : SUITE 1
City : NORMAL
State : IL
Zip : 61761-2195
Country : US
Telephone Number : 309-454-1100
Fax Number : 309-454-1107
Authorized Official
Title or Position : MANAGING DIRECTOR
Name : VIKKI L. FALLS
Credential :
Telephone Number : 309-454-1100
Provider Enumeration Date : 03/28/2007
Last Update Date : 06/22/2016

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Directions to “DEFINITIVE NEURODIAGNOSTICS LLC ” Practice Location

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