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Organization

MIDWEST NEUROPSYCHIATRIC ASSOC LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JANE CARLEY B.A. (OFFICE MANAGER)
(312) 942-9319
Entity
Organization

Contact information

Practice address
1725 W HARRISON ST, SUITE 744, CHICAGO, IL 60612-3841
(312) 942-0118
(312) 942-1331
Mailing address
1725 W HARRISON ST, SUITE 744, CHICAGO, IL 60612-3841
(312) 942-0118
(312) 942-1331

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
042002366
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1615745
BLUE CROSS-BLUE SHIELD #
IL
Enumeration date
03/13/2007
Last updated
12/27/2011
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