Provider Demographics
NPI:1295017366
Name:NEUROLOGY CARE SC
Entity Type:Organization
Organization Name:NEUROLOGY CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-993-3013
Mailing Address - Street 1:5600 N RIVER RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-6705
Mailing Address - Country:US
Mailing Address - Phone:847-993-3013
Mailing Address - Fax:847-292-4404
Practice Address - Street 1:5600 N RIVER RD
Practice Address - Street 2:SUITE 800
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-6705
Practice Address - Country:US
Practice Address - Phone:847-993-3013
Practice Address - Fax:847-292-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.127926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty