Organization
INTRANERVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL L. KOSTREVA BS CNIM (DIR. OF OPERATONS MIDWEST.)
(331) 330-3336
Entity
Organization
Contact information
Practice address
2210 ABBEYWOOD DR STE A, LISLE, IL 60532-3384
(331) 330-3336
Mailing address
2210 ABBEYWOOD DR STE A, LISLE, IL 60532-3384
(331) 330-3336
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
246ZE0600X
IL
Other
Enumeration date
05/11/2012
Last updated
05/11/2012
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