Provider Demographics
NPI:1497944508
Name:FIRST CHICAGO NEUROSCIENCE CLINIC
Entity Type:Organization
Organization Name:FIRST CHICAGO NEUROSCIENCE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JADWIGA
Authorized Official - Last Name:POPRAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-508-0373
Mailing Address - Street 1:2608 PATRIOT BLVD
Mailing Address - Street 2:102
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8024
Mailing Address - Country:US
Mailing Address - Phone:847-729-3262
Mailing Address - Fax:847-729-3261
Practice Address - Street 1:2608 PATRIOT BLVD
Practice Address - Street 2:102
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8024
Practice Address - Country:US
Practice Address - Phone:847-729-3262
Practice Address - Fax:847-729-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02273608261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216421Medicare PIN