Provider Demographics
NPI:1942333067
Name:MIDWEST NEUROLOGY ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:MIDWEST NEUROLOGY ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHLAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-872-7000
Mailing Address - Street 1:302 W HAY ST
Mailing Address - Street 2:SUITE LL110
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4167
Mailing Address - Country:US
Mailing Address - Phone:217-872-7000
Mailing Address - Fax:217-872-0417
Practice Address - Street 1:302 W HAY ST
Practice Address - Street 2:SUITE LL110
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4167
Practice Address - Country:US
Practice Address - Phone:217-872-7000
Practice Address - Fax:217-872-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN7769OtherMEDICARE RAILROAD
IL05820717OtherBLUE CROSS BLUE SHIELD
IL213505Medicare ID - Type UnspecifiedGROUP ID