Healthcare Provider Details

I. General information

NPI: 1790713634
Provider Name (Legal Business Name): PSYCHIATRIC CONSULTANTS OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 N HARLEM AVE
ELMWOOD PARK IL
60707-3119
US

IV. Provider business mailing address

2010 N HARLEM AVE
NORRIDGE IL
60706
US

V. Phone/Fax

Practice location:
  • Phone: 708-452-4443
  • Fax:
Mailing address:
  • Phone: 708-452-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: YOGI AHLUWALIA
Title or Position: PRESIDENT
Credential: MD
Phone: 708-452-4443