Organization
CLINIC OF PSYCHIATRIC CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER SMITH (CREDENTIALING AGENT)
(815) 965-8505
Entity
Organization
Contact information
Practice address
1752 WINDSOR RD, STE 203, LOVES PARK, IL 61111-4280
(815) 986-2620
Mailing address
1752 WINDSOR RD, LOVES PARK, IL 61111-4280
(815) 986-2620
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036076824
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10127233
BCBS ID
IL
Enumeration date
06/13/2008
Last updated
06/13/2008
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