Healthcare Provider Details

I. General information

NPI: 1922128388
Provider Name (Legal Business Name): DECATUR NEUROLOGICAL ASSOCIATES LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E LAKE SHORE DR STE 310
DECATUR IL
62521-3806
US

IV. Provider business mailing address

304 W HAY ST STE 214
DECATUR IL
62526-6328
US

V. Phone/Fax

Practice location:
  • Phone: 217-872-5943
  • Fax: 217-872-7665
Mailing address:
  • Phone: 217-872-5943
  • Fax: 217-872-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number042004464
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: RANA HAMID MAHMOOD
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 217-872-5943