Advanced Neuroscience Innovation Institute LLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

036141087 Issued in IL

Legal business name

ADVANCED NEUROSCIENCE INNOVATION INSTITUTE LLC

Practice address

5666 E State St
Rockford, IL 61108-2425

Phone

(815) 395-5261

Fax

(815) 381-7581

NPI assigned

Nov 23, 2016

Last updated

Nov 23, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Akram Shhadeh, MD

Title

President/Owner

Phone

(973) 901-5457

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1801339858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "THIENSVILLE",
            "state": "WI",
            "postal_code": "530920639",
            "telephone_number": "414-247-9005",
            "fax_number": "414-247-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5666 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082425",
            "telephone_number": "815-395-5261",
            "fax_number": "815-381-7581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED NEUROSCIENCE INNOVATION INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-23",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "SHHADEH",
        "authorized_official_first_name": "AKRAM",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "973-901-5457",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IL",
            "license": "036141087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE  DR GHEITH",
            "identifier": "036140536",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE  DR SHHADEH",
            "identifier": "036.141087",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neurological Surgery Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Neurological Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.