Provider Demographics
NPI:1124453279
Name:MIDWEST NEUROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:MIDWEST NEUROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-2096
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-0423
Mailing Address - Country:US
Mailing Address - Phone:219-836-2096
Mailing Address - Fax:219-836-2097
Practice Address - Street 1:1100 JOLIET ST STE 201
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1995
Practice Address - Country:US
Practice Address - Phone:219-836-2096
Practice Address - Fax:219-836-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073001A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty