Organization
PSYCHIATRIC CLINICS OF NORTHERN ILLINOIS PC
Active
Organization
PSYCHIATRIC CLINICS OF NORTHERN ILLINOIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM AZAR (OFFICE MANAGER)
(815) 229-7227
Entity
Organization
Contact information
Practice address
1639 N ALPINE RD, ROCKFORD, IL 61107-1449
(815) 229-7227
(815) 229-7288
Mailing address
1639 N ALPINE RD, ROCKFORD, IL 61107-1449
(815) 229-7227
(815) 229-7288
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036079335
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010100667
BCBS OF ILLINOIS
IL
Enumeration date
03/12/2007
Last updated
07/01/2009
Update your record
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