Healthcare Provider Details

I. General information

NPI: 1518999010
Provider Name (Legal Business Name): NEUROLOGY CLINIC OF MARIN, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 RED HILL AVE
SAN ANSELMO CA
94960
US

IV. Provider business mailing address

PO BOX 618
NOVATO CA
94948-0618
US

V. Phone/Fax

Practice location:
  • Phone: 415-456-8180
  • Fax: 415-453-4898
Mailing address:
  • Phone: 415-456-8180
  • Fax: 415-453-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA71057
License Number StateCA

VIII. Authorized Official

Name: DR. ILKCAN COKGOR
Title or Position: PRES
Credential: M.D.
Phone: 415-456-8180