Healthcare Provider Details

I. General information

NPI: 1790763407
Provider Name (Legal Business Name): NEUROLOGY SPECIALISTS OF NORTHERN ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 GOLF RD SUITE 303
DES PLAINES IL
60016-1667
US

IV. Provider business mailing address

9301 GOLF RD SUITE 303
DES PLAINES IL
60016-1667
US

V. Phone/Fax

Practice location:
  • Phone: 847-298-4088
  • Fax: 847-627-8700
Mailing address:
  • Phone: 847-298-4088
  • Fax: 847-627-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI A KIRBY-PEARCE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 847-627-8701