Organization
MCLEAN COUNTY NEUROLOGY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERMAN JUSTUS DICK JR. MD (MANAGING PARTNER)
(309) 662-9461
Entity
Organization
Contact information
Practice address
2204 EASTLAND DR, BLOOMINGTON, IL 61704-3566
(309) 662-9461
Mailing address
2204 EASTLAND DR, BLOOMINGTON, IL 61704-3566
(309) 662-9461
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5715381
BLUE CROSS BLUE SHIELD
IL
01
—
CF6543
MEDID
IL
Enumeration date
05/08/2006
Last updated
06/05/2008
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