# MATHERS CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215194519
- **Authorized official:** DR. RAMESH BABU VEMURI MD (VICE PRESIDENT)
- **Authorized official phone:** (815) 397-7654

## Contact information

- **Practice address:** 5804 ELAINE DR, ROCKFORD, IL 61108-2435
- **Practice address phone:** (815) 397-7654
- **Practice address fax:** (815) 397-2712
- **Mailing address:** 8420 W BRYN MAWR AVE, SUITE 620, CHICAGO, IL 60631-3479
- **Mailing address phone:** (773) 775-2800
- **Mailing address fax:** (773) 775-3366

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 36039266 | IL | Yes |

## Other

- **Enumeration date:** 05/22/2008
- **Last updated:** 05/22/2008