=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073529897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RMU NEUROLOGY SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 03/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4121 FAIRVIEW AVE 204
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-2264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-964-7136
-----------------------------------------------------
Fax | 630-353-0765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4121 FAIRVIEW AVE 204
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-2264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-964-7136
-----------------------------------------------------
Fax | 630-353-0765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RODRIGO M UBILUZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 630-964-7136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 036081581
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------