Provider Demographics
NPI:1972859510
Name:FOREST PARK NEUROLOGY LLC
Entity Type:Organization
Organization Name:FOREST PARK NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:847-251-2400
Mailing Address - Street 1:5811 E TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64126-2400
Mailing Address - Country:US
Mailing Address - Phone:816-600-1816
Mailing Address - Fax:877-274-1845
Practice Address - Street 1:5811 E TRUMAN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64126-2400
Practice Address - Country:US
Practice Address - Phone:816-600-1816
Practice Address - Fax:877-274-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1116914103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty