Organization
DIAGNOSTIC NEUROLOGY, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULES T KOVELESKI M.D. (PRESIDENT)
(847) 825-2366
Entity
Organization
Contact information
Practice address
444 N NORTHWEST HWY, STE 200, PARK RIDGE, IL 60068-3263
(847) 825-2366
(847) 825-2513
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(773) 767-8283
(773) 767-8320
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01615936
BLUE SHIELD
IL
Enumeration date
05/17/2006
Last updated
08/22/2020
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