Healthcare Provider Details

I. General information

NPI: 1699639435
Provider Name (Legal Business Name): AMANA BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S STATE ST UNIT 1416
CHICAGO IL
60605-3580
US

IV. Provider business mailing address

1440 W TAYLOR ST STE 4310
CHICAGO IL
60607-4623
US

V. Phone/Fax

Practice location:
  • Phone: 312-809-9747
  • Fax:
Mailing address:
  • Phone: 312-809-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED ISMAIL
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 312-809-9747