Organization
MED PSYCHE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN EVANGELISTA (OWNER)
(312) 912-3444
Entity
Organization
Contact information
Practice address
1108 W GRANVILLE AVE, CHICAGO, IL 60660-2013
(312) 912-3444
Mailing address
1108 W GRANVILLE AVE, CHICAGO, IL 60660-2013
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/26/2024
Last updated
07/17/2025
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