Provider Demographics
NPI:1063539641
Name:SOUTH SUBURBAN NEUROLOGY LTD
Entity type:Organization
Organization Name:SOUTH SUBURBAN NEUROLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TURPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-957-2993
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60412-0280
Mailing Address - Country:US
Mailing Address - Phone:708-957-3737
Mailing Address - Fax:708-957-2516
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:STE 110
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2013
Practice Address - Country:US
Practice Address - Phone:708-957-3737
Practice Address - Fax:708-957-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL695540Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER