Organization
CNS NEUROLOGICAL SURGERY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STAVROS NICHOLAS MALTEZOS M.D. (PRESIDENT)
(630) 725-9890
Entity
Organization
Contact information
Practice address
3825 HIGHLAND AVE, TOWER 1, SUITE 5M, DOWNERS GROVE, IL 60515-1552
(630) 725-9890
(630) 725-0988
Mailing address
PAYSPHERE CIR DEPT 9029, CHICAGO, IL 60674
(630) 725-9890
(630) 725-0988
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001617783
BLUE SHIELD
IL
Enumeration date
10/17/2006
Last updated
07/21/2022
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