Healthcare Provider Details

I. General information

NPI: 1982944096
Provider Name (Legal Business Name): HOLISTIC BEHAVIORAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAST OGDEN AVENUE 220
HINSDALE IL
60521
US

IV. Provider business mailing address

120 E OGDEN AVE SUITE 220
HINSDALE IL
60521-3542
US

V. Phone/Fax

Practice location:
  • Phone: 630-321-0264
  • Fax:
Mailing address:
  • Phone: 630-321-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number036115802
License Number StateIL

VIII. Authorized Official

Name: DR. HUMA F PANDIT
Title or Position: PRERSIDENT
Credential: M.D
Phone: 630-321-0264