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General NPI Number Information
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NPI Number | 1467469007
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Entity Type | Organization
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Legal Business Name | ILLINOIS INSTITUTE OF NEUROLOGY LTD
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 2 MEMORIAL DR SUITE 201
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City | ALTON
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State | IL
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Zip | 62002-6723
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Country | US
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Telephone | 314-355-3355
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Fax |
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Provider Business Mailing Address
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Address Line | 11155 DUNN RD SUITE 202N
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6150
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Country | US
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Telephone | 314-355-3355
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Fax | 314-355-6584
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT P MARGOLIS
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Credential | M.D.
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Telephone | 314-355-3355
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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 |
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