Organization
NEUROLOGY OF SOUTHERN ILLINOIS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORI MARIE GUYTON MD (M.D.)
(618) 993-0444
Entity
Organization
Contact information
Practice address
3301 LOGAN DR, HERRIN, IL 62948-3732
(618) 993-0444
(618) 998-9302
Mailing address
3301 LOGAN DR, HERRIN, IL 62948-3732
(618) 993-0444
(618) 998-9302
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10008620
BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/19/2007
Last updated
08/22/2020
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