| Elkhart Neurology Pc | |
|
2746 Old Us 20 W Suite A Elkhart IN 46514-1364 | |
| (574) 522-7624 | |
| (574) 522-9405 |
| Full Name | Elkhart Neurology Pc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 2746 Old Us 20 W, Elkhart, Indiana |
| Authorized Official Name and Position | Patrick W Russell (PRESIDENT) |
| Authorized Official Contact | 5745227624 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elkhart Neurology Pc 2746 Old Us 20 W Suite A Elkhart IN 46514-1364 Ph: (574) 522-7624 | Elkhart Neurology Pc 2746 Old Us 20 W Suite A Elkhart IN 46514-1364 Ph: (574) 522-7624 |
| NPI Number | 1306976717 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 05/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306976717 | NPI | - | NPPES |
| 100114080B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 02001219 (Indiana) | Primary |
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