Provider Demographics
NPI:1922128388
Name:DECATUR NEUROLOGICAL ASSOCIATES LTD.
Entity Type:Organization
Organization Name:DECATUR NEUROLOGICAL ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANA
Authorized Official - Middle Name:HAMID
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-872-5943
Mailing Address - Street 1:304 W HAY ST
Mailing Address - Street 2:STE 214
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-872-5943
Mailing Address - Fax:217-872-7665
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:STE 214
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-872-5943
Practice Address - Fax:217-872-7665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR NEUROLOGICAL ASSOCIATES LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-30
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042004464261QM2500X
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045992Medicaid
G83573Medicare UPIN