Provider Demographics
NPI:1730275223
Name:BRUSIL, OLGA O (MD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:O
Last Name:BRUSIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 MILWAUKEE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2464
Mailing Address - Country:US
Mailing Address - Phone:847-296-2193
Mailing Address - Fax:
Practice Address - Street 1:1247 MILWAUKEE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2464
Practice Address - Country:US
Practice Address - Phone:847-296-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1086462084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1053843230OtherNEURODIAG CONSULTANTS,LLC