Provider Demographics
NPI:1851391262
Name:MIDWEST NEUROLOGICAL P.C.
Entity Type:Organization
Organization Name:MIDWEST NEUROLOGICAL P.C.
Other - Org Name:MIDWEST NEUROLOGICAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEM
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-476-7523
Mailing Address - Street 1:1312 PROFESSIONAL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8007
Mailing Address - Country:US
Mailing Address - Phone:812-476-7523
Mailing Address - Fax:812-476-6686
Practice Address - Street 1:1312 PROFESSIONAL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8007
Practice Address - Country:US
Practice Address - Phone:812-476-7523
Practice Address - Fax:812-476-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003893A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200187610AMedicaid
IN200271070AMedicaid
IN100329890AMedicaid
IN200271080AMedicaid
H20023Medicare UPIN
E66007Medicare UPIN
069540EMedicare ID - Type Unspecified
F79076Medicare UPIN