Provider Demographics
NPI:1124526272
Name:NEUROLOGY CLINIC OF CHICAGO, LLC
Entity type:Organization
Organization Name:NEUROLOGY CLINIC OF CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIRAJUDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-552-1355
Mailing Address - Street 1:4909 W DIVISION ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3161
Mailing Address - Country:US
Mailing Address - Phone:773-552-1355
Mailing Address - Fax:
Practice Address - Street 1:4909 W DIVISION ST STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3161
Practice Address - Country:US
Practice Address - Phone:773-832-7100
Practice Address - Fax:833-832-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty