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General NPI Number Information
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NPI Number | 1609964543
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Entity Type | Organization
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Legal Business Name | TRI-CITY NEUROLOGY ASSOCIATES, LTD.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 6828 STATE ROUTE 162
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City | MARYVILLE
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State | IL
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Zip | 62062-8558
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Country | US
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Telephone | 618-288-5906
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Fax | 618-288-5914
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Provider Business Mailing Address
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Address Line | 6828 STATE ROUTE 162
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City | MARYVILLE
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State | IL
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Zip | 62062-8558
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Country | US
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Telephone | 618-288-5906
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Fax | 618-288-5914
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RIAZ A NASEER
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Credential | M.D.
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Telephone | 618-288-5906
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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 | 3649365
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License Number State | IL
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