Neurology Clinic of Chicago, LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

NEUROLOGY CLINIC OF CHICAGO, LLC

Practice address

4909 W Division St Ste 302
Chicago, IL 60651-3161

Phone

(773) 832-7100

Fax

(833) 832-7100

NPI assigned

Jan 23, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohamed S Sirajudeen

Title

Manager

Phone

(773) 552-1355

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1124526272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 W DIVISION ST STE 302",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606513161",
            "telephone_number": "773-552-1355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 W DIVISION ST STE 302",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606513161",
            "telephone_number": "773-832-7100",
            "fax_number": "833-832-7100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4909 W Division St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606513161",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEUROLOGY CLINIC OF CHICAGO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "SIRAJUDEEN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-552-1355"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.