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Organization
MIDWEST NEUROFITNESS
Active
Organization
MIDWEST NEUROFITNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM ANDREW HOGAN PHD (MAJORITY PARTNER)
(217) 348-1086
Entity
Organization
Contact information
Practice address
313 N MATTIS AVE, SUITE 205, CHAMPAIGN, IL 61821-2460
(217) 348-1086
(217) 355-4012
Mailing address
PO BOX 584, CHARLESTON, IL 61920-0584
(217) 348-1086
(217) 355-4012
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180-002663
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01532018
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/10/2007
Last updated
07/07/2008
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