Organization
NEUROCENTER S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE L. MEDINA MD (CEO AND MEDICAL DIRECTOR)
(773) 775-7540
Entity
Organization
Contact information
Practice address
6225 W TOUHY AVE, CHICAGO, IL 60646-1105
(773) 775-7540
Mailing address
5015 N PAULINA ST, SUITE 325, CHICAGO, IL 60640-2756
(773) 775-7540
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036048770
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048770
—
IL
Enumeration date
04/13/2007
Last updated
11/24/2010
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