MEDICARE: TRI-CITY NEUROLOGY SC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K14614	OTHER		MEDICARE
2	130017803	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	4522081	OTHER	IL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	163660582166	OTHER		HUMANA
6	4740209004	OTHER		CIGNA
7	5338653	OTHER		AETNA

General Provider Information

NPI Number	:	1174502611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-CITY NEUROLOGY SC

Provider Business Mailing Address
First Line	:	2210 DEAN ST STE D
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-1059
Country	:	US
Telephone Number	:	630-587-2068
Fax Number	:	630-587-2081

Provider Business Practice Location Address
First Line	:	2210 DEAN ST STE D
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-1059
Country	:	US
Telephone Number	:	630-587-2068
Fax Number	:	630-587-2081

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NICHOLAS L SCHLAGETER
Credential	:	MD
Telephone Number	:	630-587-2068

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	01/23/2015

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Directions to “TRI-CITY NEUROLOGY SC ” Practice Location

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