Healthcare Provider Details

I. General information

NPI: 1144972860
Provider Name (Legal Business Name): IATREIA MENTAL HEALTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 RICHARDS ST
JOLIET IL
60433-2745
US

IV. Provider business mailing address

1225 RICHARDS ST
JOLIET IL
60433-2745
US

V. Phone/Fax

Practice location:
  • Phone: 312-554-5431
  • Fax:
Mailing address:
  • Phone: 312-554-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BIKRAM SHARMA
Title or Position: MD/OWNER
Credential:
Phone: 708-829-2706