Provider Demographics
NPI:1598755456
Name:UNIVERSITY HEAD AND NECK ASSOCIATES, SC
Entity type:Organization
Organization Name:UNIVERSITY HEAD AND NECK ASSOCIATES, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOFCHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-574-8222
Mailing Address - Street 1:3800 HIGHLAND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1558
Mailing Address - Country:US
Mailing Address - Phone:630-701-3840
Mailing Address - Fax:630-574-8225
Practice Address - Street 1:3800 HIGHLAND AVE STE 105
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1558
Practice Address - Country:US
Practice Address - Phone:630-701-3840
Practice Address - Fax:630-574-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01619292OtherBCBSIL GROUP NUMBER
IL01619292OtherBLUE SHIELD PPO
ILDE2650Medicare PIN
IL212417Medicare PIN
IL501100Medicare PIN
ILDE2663Medicare PIN
01619292OtherBCBSIL GROUP NUMBER