Individual
SHADY GEORGY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
751 N RUTLEDGE ST, SPRINGFIELD, IL 62702-4968
(217) 545-8000
Mailing address
751 N RUTLEDGE ST, SPRINGFIELD, IL 62702-4968
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
125068547
IL
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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