Healthcare Provider Details

I. General information

NPI: 1194212399
Provider Name (Legal Business Name): VICTOR C NEUMANN ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 N NASHVILLE AVE
CHICAGO IL
60634-1429
US

IV. Provider business mailing address

5547 N RAVENSWOOD AVE
CHICAGO IL
60640-1125
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-4313
  • Fax: 773-769-1476
Mailing address:
  • Phone: 773-506-3201
  • Fax: 773-769-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: LINDA A BRUGGEMANN
Title or Position: BILLING COORDINATOR
Credential:
Phone: 773-506-3201