MEDICARE: NEPTUNE

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	251V00000X	Voluntary or Charitable Agency
2	207R00000X	Internal Medicine Physician	11O49IK	ZZ

General Provider Information

NPI Number	:	1720447667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPTUNE

Provider Business Mailing Address
First Line	:	2189 N IL ROUTE 83 STE 220
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-4906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2189 N IL ROUTE 83 STE 220
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-4906
Country	:	US
Telephone Number	:	312-857-5382
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KUMAR DINESH
Credential	:
Telephone Number	:	312-857-5382

Provider Enumeration Date	:	02/21/2016
Last Update Date	:	05/09/2016

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Directions to “NEPTUNE ” Practice Location

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