MEDICARE: MINDFUL PSYCHIATRIC CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1063024925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL PSYCHIATRIC CARE LLC

Provider Business Mailing Address
First Line	:	120 E OGDEN AVE STE 101
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-3892
Country	:	US
Telephone Number	:	630-366-7330
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E OGDEN AVE STE 101
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-3892
Country	:	US
Telephone Number	:	630-366-7330
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MURALIDHARA RAO
Credential	:	MD
Telephone Number	:	630-366-7330

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	10/22/2020

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