Healthcare Provider Details

I. General information

NPI: 1932224946
Provider Name (Legal Business Name): MIDWEST NEUROLOGICAL ASSOCIATES LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 ESSINGTON RD
JOLIET IL
60435-4912
US

IV. Provider business mailing address

1513 ESSINGTON RD
JOLIET IL
60435-4912
US

V. Phone/Fax

Practice location:
  • Phone: 815-730-1200
  • Fax: 815-730-1066
Mailing address:
  • Phone: 815-730-1200
  • Fax: 815-730-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number03609242IL
License Number StateIL

VIII. Authorized Official

Name: DR. GRAZYNA PIEKOS
Title or Position: OWNER
Credential: MD
Phone: 815-730-1200