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Organization

NEUROMED CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY L BANKS (DIRECTOR PATIENT SERVICES)
(630) 836-9121
Entity
Organization

Contact information

Practice address
3S517 WINFIELD RD, STE A, WARRENVILLE, IL 60555-3159
(630) 836-9121
Mailing address
3S517 WINFIELD RD, STE A, WARRENVILLE, IL 60555-3159
(630) 836-9121

Taxonomy

Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
2084N0400X
Neurology Physician
036075202
IL
2084N0400X
Neurology Physician
036093821
IL
2084N0400X
Neurology Physician
036095842
IL
2084N0400X
Neurology Physician
Primary
036111136
IL
2084N0600X
Clinical Neurophysiology Physician
036111136
IL
2084N0600X
Clinical Neurophysiology Physician
036121731
IL
2084P0800X
Psychiatry Physician
036107234
IL
2084V0102X
Vascular Neurology Physician
036075202
IL
2084V0102X
Vascular Neurology Physician
036093821
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036075202
IL
05
036093821
IL
05
036107234
IL
05
036111136
IL
05
036121731
IL
05
1316982846
IL
05
209006135
IL
01
220232500
DOL
IL
01
2232580
BCBS
IL
01
CD3784
GROUP RAILROAD MEDICARE
IL
Enumeration date
06/18/2006
Last updated
09/15/2009
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