MEDICARE: MARCIA E NEIL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L33388	OTHER	IL	PIN UNKNOWN TYPE

General Provider Information

NPI Number	:	1104965557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA E NEIL M.D.

Provider Business Mailing Address
First Line	:	1520 LANG DR
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60490-1019
Country	:	US
Telephone Number	:	630-759-3083
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 S GARY AVE
Second Line	:	CDH CONVENIENT CARE AT STRATFORD NORTH
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-2213
Country	:	US
Telephone Number	:	630-893-9600
Fax Number	:	630-893-9675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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