Organization
NEUROLOGY CLINIC OF DANVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VATHIAR A TAZUDEEN M.D. (OWNER)
(217) 431-8400
Entity
Organization
Contact information
Practice address
701 W FAIRCHILD ST, DANVILLE, IL 61832-3745
(217) 431-8400
(217) 431-0387
Mailing address
701 W. FAIRCHILD STREET, DANVILLE, IL 61832-3745
(217) 431-8400
(217) 431-0387
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036061107
IL
Other
Enumeration date
04/24/2008
Last updated
04/24/2008
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