Organization
MIDWEST NEUROLOGY ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER LYNICE DAUGHERTY (OFFICE MANAGER)
(217) 872-7000
Entity
Organization
Contact information
Practice address
302 W HAY ST, SUITE LL110, DECATUR, IL 62526-4167
(217) 872-7000
Mailing address
302 W HAY ST, SUITE LL110, DECATUR, IL 62526-4167
(217) 872-7000
(217) 233-1564
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036093353
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093353
—
IL
Enumeration date
08/12/2008
Last updated
08/12/2008
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