Provider Demographics
NPI:1104965557
Name:NEIL, MARCIA E (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:E
Last Name:NEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:E
Other - Last Name:NEIL-BEDNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1520 LANG DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-1019
Mailing Address - Country:US
Mailing Address - Phone:630-759-3083
Mailing Address - Fax:
Practice Address - Street 1:235 S GARY AVE
Practice Address - Street 2:CDH CONVENIENT CARE AT STRATFORD NORTH
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2213
Practice Address - Country:US
Practice Address - Phone:630-893-9600
Practice Address - Fax:630-893-9675
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL33388OtherPIN UNKNOWN TYPE
ILL33388OtherPIN UNKNOWN TYPE
ILE18684Medicare UPIN