Provider Demographics
NPI:1528079977
Name:NEURODIAGNOSTIC SERVICES LTD
Entity type:Organization
Organization Name:NEURODIAGNOSTIC SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-388-4902
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:2310 YORK ST
Practice Address - Street 2:#2C
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2411
Practice Address - Country:US
Practice Address - Phone:708-388-4902
Practice Address - Fax:708-388-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL031603006OtherBCBS PROVIDER ID
ILCL0157OtherRAIL ROAD MEDICARE
IL131781400OtherACS HEALTHNET
IL131781400OtherACS HEALTHNET
IL031603006OtherBCBS PROVIDER ID
ILCL0157Medicare PIN