=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295017366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROLOGY CARE SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2011
-----------------------------------------------------
Last Update Date | 09/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 N RIVER RD SUITE 800
-----------------------------------------------------
City | ROSEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-6705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-993-3013
-----------------------------------------------------
Fax | 847-292-4404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5600 N RIVER RD SUITE 800
-----------------------------------------------------
City | ROSEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-6705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-993-3013
-----------------------------------------------------
Fax | 847-292-4404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RUSSELL PACKARD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 847-993-3013
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 036.127926
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------