MEDICARE: PATHWAY HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	036084695	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043445935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAY HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	5544 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2217
Country	:	US
Telephone Number	:	773-561-5400
Fax Number	:	773-561-5402

Provider Business Practice Location Address
First Line	:	5544 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2217
Country	:	US
Telephone Number	:	773-561-5400
Fax Number	:	773-561-5402

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOEL S MOSTOW
Credential	:	M.D.
Telephone Number	:	773-561-5400

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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Directions to “PATHWAY HEALTH SERVICES LLC ” Practice Location

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