Provider Demographics
NPI:1164475737
Name:DIAGNOSTIC NEUROLOGY, LTD
Entity Type:Organization
Organization Name:DIAGNOSTIC NEUROLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULES
Authorized Official - Middle Name:T
Authorized Official - Last Name:KOVELESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-825-2366
Mailing Address - Street 1:PO BOX 388320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8320
Mailing Address - Country:US
Mailing Address - Phone:773-767-8283
Mailing Address - Fax:773-767-8320
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:STE 200
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3263
Practice Address - Country:US
Practice Address - Phone:847-825-2366
Practice Address - Fax:847-825-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615936OtherBLUE SHIELD
IL603770Medicare ID - Type Unspecified