Provider Demographics
NPI:1063401180
Name:NEUROLOGICAL SURGERY INC
Entity type:Organization
Organization Name:NEUROLOGICAL SURGERY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:DETWILER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-492-7587
Mailing Address - Street 1:6767 S YALE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3302
Mailing Address - Country:US
Mailing Address - Phone:918-492-7587
Mailing Address - Fax:918-491-3542
Practice Address - Street 1:6767 S YALE AVE
Practice Address - Street 2:STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3302
Practice Address - Country:US
Practice Address - Phone:918-492-7500
Practice Address - Fax:918-491-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty