Basic Information
| Provider Information | |||||||||
| NPI: | 1982646584 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROLOGICAL & SPINAL SURGERY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 E 89TH AVE | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464107318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197562900 | ||||||||
| FaxNumber: | 2197562910 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E 89TH AVE | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464107318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197562900 | ||||||||
| FaxNumber: | 2197562910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 09/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | RIFAI | ||||||||
| AuthorizedOfficialFirstName: | M | ||||||||
| AuthorizedOfficialMiddleName: | HYTHAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2197562900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100215300 | 05 | IN | MEDICAID |