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
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