Provider Demographics
NPI:1801835202
Name:CHICAGO NEUROLOGY GROUP SC
Entity Type:Organization
Organization Name:CHICAGO NEUROLOGY GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPA
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:847-852-1428
Mailing Address - Street 1:6321 N AVONDALE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:773-975-6773
Mailing Address - Fax:
Practice Address - Street 1:6321 N AVONDALE
Practice Address - Street 2:SUITE 106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-975-6773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
IL0360604382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633088OtherBLUE CROSS
IL6063101Medicaid
IL01633088OtherBLUE CROSS
IL204399Medicare UPIN