Provider Demographics
NPI:1720447667
Name:NEPTUNE
Entity Type:Organization
Organization Name:NEPTUNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DINESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-857-5382
Mailing Address - Street 1:2189 N IL ROUTE 83 STE 220
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2189 N IL ROUTE 83 STE 220
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-4906
Practice Address - Country:US
Practice Address - Phone:312-857-5382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-21
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ11O49IK207R00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty