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General NPI Number Information
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NPI Number | 1275940959
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Entity Type | Organization
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Legal Business Name | DANVILLE NEUROLOGY, LLC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 701 W FAIRCHILD ST LOWER LEVEL
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City | DANVILLE
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State | IL
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Zip | 61832-3745
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Country | US
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Telephone | 217-431-8400
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Fax | 217-431-0387
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Provider Business Mailing Address
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Address Line | 701 W FAIRCHILD ST LOWER LEVEL
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City | DANVILLE
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State | IL
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Zip | 61832-3745
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Country | US
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Telephone | 217-431-8400
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Fax | 217-431-0387
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAHID A TAZUDEEN
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Credential | M.D.
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Telephone | 217-431-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State | IL
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