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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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