Organization
MATHERS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAMESH BABU VEMURI MD (VICE PRESIDENT)
(815) 397-7654
Entity
Organization
Contact information
Practice address
5804 ELAINE DR, ROCKFORD, IL 61108-2435
(815) 397-7654
(815) 397-2712
Mailing address
8420 W BRYN MAWR AVE, SUITE 620, CHICAGO, IL 60631-3479
(773) 775-2800
(773) 775-3366
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
36039266
IL
Other
Enumeration date
05/22/2008
Last updated
05/22/2008
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