Provider Demographics
NPI:1124028915
Name:NEUROLOGIC CONSULTANTS, PA
Entity Type:Organization
Organization Name:NEUROLOGIC CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JULLIUS
Authorized Official - Middle Name:ILAO
Authorized Official - Last Name:ANCHETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-412-1208
Mailing Address - Street 1:517 RIVIERA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2827
Mailing Address - Country:US
Mailing Address - Phone:941-412-1208
Mailing Address - Fax:941-412-1248
Practice Address - Street 1:517 RIVIERA ST
Practice Address - Street 2:SUITE A
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2827
Practice Address - Country:US
Practice Address - Phone:941-412-1208
Practice Address - Fax:941-412-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME805122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264553000Medicaid
FL58680OtherBCBS
FL58680Medicare ID - Type Unspecified
FL264553000Medicaid