Basic Information
| Provider Information | |||||||||
| NPI: | 1396317111 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHIATRY PHYSICIANS GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1S376 SUMMIT AVE STE 4C | ||||||||
| Address2: | |||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304241122 | ||||||||
| FaxNumber: | 6303962677 | ||||||||
| Practice Location | |||||||||
| Address1: | 1S376 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303177042 | ||||||||
| FaxNumber: | 6303240067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2021 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | NOBLE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6304241122 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084B0040X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry |
No ID Information.