Healthcare Provider Details

I. General information

NPI: 1265509392
Provider Name (Legal Business Name): CENTRAL IL PSYCHIATRIC ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 KAYS DRIVE SUITE B
NORMAL IL
61761
US

IV. Provider business mailing address

405 KAYS DR SUITE B
NORMAL IL
61761-1979
US

V. Phone/Fax

Practice location:
  • Phone: 309-862-0064
  • Fax: 309-862-1542
Mailing address:
  • Phone: 309-862-0064
  • Fax: 309-862-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAJU N PATURI
Title or Position: OWNER
Credential: MD
Phone: 309-862-0064