Organization
JAI YESU PSYCHIATRIC SERVICES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE MATHEWS M.D. (PRESIDENT)
(540) 467-3615
Entity
Organization
Contact information
Practice address
4711 N LAPORTE AVE, CHICAGO, IL 60630-3830
(540) 467-3615
Mailing address
4711 N LAPORTE AVE, CHICAGO, IL 60630-3830
(540) 467-3615
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036.121203
IL
Other
Enumeration date
12/27/2009
Last updated
11/08/2010
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