Provider Demographics
NPI:1811048036
Name:MIDWEST NEUROLOGY, LTD.
Entity type:Organization
Organization Name:MIDWEST NEUROLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-906-9470
Mailing Address - Street 1:181 S LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1609
Mailing Address - Country:US
Mailing Address - Phone:630-906-9470
Mailing Address - Fax:630-906-9467
Practice Address - Street 1:181 S LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1609
Practice Address - Country:US
Practice Address - Phone:630-906-9470
Practice Address - Fax:630-906-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0747552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4522088OtherBLUECROSS BLUESHIELD
ILB57031Medicare UPIN
ILCN8758Medicare PIN
IL209526Medicare PIN
IL209594Medicare PIN