| Organization Name: | NEUROMED CLINIC LLC |
| NPI Number: | 1043410772 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY L BANKS (DIRECTOR PHYSICIAN & PATIENT SVCS) |
| Mailing Address: | 25 N Winfield Rd Ste 500 Winfield |
| State: | IL US |
| Postal Code: | 601901222 |
| Phone Number: | 6308369121 |
| Fax Number: | 6308369126 |
| NPI Enumeration Date: | 07/20/2007 |
| NPI Last Update Date: | 10/27/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207SG0201X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Medical Genetics |
| Taxonomy Specialization: | Clinical Genetics (M.D.) |
| Taxonomy Definition: | A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |