Organization
LIBERTYVILLE NEUROSURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN S CITOW (OWNER)
(847) 362-1848
Entity
Organization
Contact information
Practice address
712 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3279
(847) 362-1848
(847) 362-3351
Mailing address
712 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3279
(847) 362-1848
(847) 362-3351
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36066065
—
IL
Enumeration date
04/04/2008
Last updated
02/06/2012
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