Provider Demographics
NPI:1932224946
Name:MIDWEST NEUROLOGICAL ASSOCIATES LTD.
Entity Type:Organization
Organization Name:MIDWEST NEUROLOGICAL ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAZYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIEKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-730-1200
Mailing Address - Street 1:1513 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-4912
Mailing Address - Country:US
Mailing Address - Phone:815-730-1200
Mailing Address - Fax:815-730-1066
Practice Address - Street 1:1513 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-4912
Practice Address - Country:US
Practice Address - Phone:815-730-1200
Practice Address - Fax:815-730-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03609242IL2084N0400X
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090242Medicaid
IL036090242Medicaid