Organization
ADVANCED NEUROSCIENCE INNOVATION INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AKRAM SHHADEH MD (PRESIDENT/OWNER)
(973) 901-5457
Entity
Organization
Contact information
Practice address
5666 E STATE ST, ROCKFORD, IL 61108-2425
(815) 395-5261
(815) 381-7581
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 247-9005
(414) 247-9004
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
036141087
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.141087
LICENSE DR SHHADEH
IL
01
—
036140536
LICENSE DR GHEITH
IL
Enumeration date
11/23/2016
Last updated
11/23/2016
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