Provider Demographics
NPI:1760495311
Name:NEUROLOGY ASSOCIATES LTD.
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-331-6617
Mailing Address - Street 1:71 W 156TH ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4260
Mailing Address - Country:US
Mailing Address - Phone:708-331-6617
Mailing Address - Fax:708-331-7957
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-331-6617
Practice Address - Fax:708-331-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-07812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL042-07812OtherGROUP LICENSE NUMBER
01617846OtherBLUE CROSS PROVIDER NO.
01617846OtherBLUE CROSS PROVIDER NO.