Provider Demographics
NPI:1477532232
Name:FLORENCE, NEAL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:RICHARD
Last Name:FLORENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 W PETERSON
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646
Mailing Address - Country:US
Mailing Address - Phone:773-427-0398
Mailing Address - Fax:773-282-4574
Practice Address - Street 1:4801 W PETERSON
Practice Address - Street 2:SUITE 217
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646
Practice Address - Country:US
Practice Address - Phone:773-427-0398
Practice Address - Fax:773-282-4574
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360681662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry