Provider Demographics
NPI:1942335849
Name:COMPREHENSIVE NEUROLOGIC SERVICES PC
Entity Type:Organization
Organization Name:COMPREHENSIVE NEUROLOGIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUCKWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-718-1355
Mailing Address - Street 1:5250 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9199
Mailing Address - Country:US
Mailing Address - Phone:317-718-1355
Mailing Address - Fax:317-718-1358
Practice Address - Street 1:5250 E US HIGHWAY 36
Practice Address - Street 2:SUITE 210
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9199
Practice Address - Country:US
Practice Address - Phone:317-718-1355
Practice Address - Fax:317-718-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN345440Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER