| Community Neurologic Center SC | |
|
2172 Blackberry Dr Suite 202 Geneva IL 60134-1073 | |
| (630) 208-7735 | |
| (630) 208-6956 |
| Full Name | Community Neurologic Center SC |
|---|---|
| Speciality | Clinic/center |
| Location | 2172 Blackberry Dr, Geneva, Illinois |
| Authorized Official Name and Position | Boris Lake (BUSINESS MANAGER) |
| Authorized Official Contact | 6302087735 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Neurologic Center SC 2172 Blackberry Dr Suite 202 Geneva IL 60134-1073 Ph: (630) 208-7735 | Community Neurologic Center SC 2172 Blackberry Dr Suite 202 Geneva IL 60134-1073 Ph: (630) 208-7735 |
| NPI Number | 1487852679 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 09/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487852679 | NPI | - | NPPES |
| 036-093008 | Other | IL | MEDICAL LICENSE |
| 036093008 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 036-093008 (Illinois) | Primary |
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