Provider Demographics
NPI:1609964543
Name:TRI-CITY NEUROLOGY ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:TRI-CITY NEUROLOGY ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-288-5906
Mailing Address - Street 1:6828 STATE ROUTE 162
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8558
Mailing Address - Country:US
Mailing Address - Phone:618-288-5906
Mailing Address - Fax:618-288-5914
Practice Address - Street 1:6828 STATE ROUTE 162
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8558
Practice Address - Country:US
Practice Address - Phone:618-288-5906
Practice Address - Fax:618-288-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36493652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA28455Medicare UPIN
IL231060Medicare ID - Type Unspecified