Organization
WIS-PER PSYCHIATRIC SERVICES S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RITA MARIA LEWIS-PERRY M.D. (PRESIDENT)
(708) 296-1759
Entity
Organization
Contact information
Practice address
16233 WAUSAU AVE, SOUTH HOLLAND, IL 60473-2157
(708) 643-1753
(708) 418-0620
Mailing address
16233 WAUSAU AVE, SOUTH HOLLAND, IL 60473-2157
(708) 643-1753
(708) 418-0620
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036-084974
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036084974
—
IL
Enumeration date
11/12/2008
Last updated
11/12/2008
Update your record
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