Healthcare Provider Details

I. General information

NPI: 1184981151
Provider Name (Legal Business Name): CHICAGO PSYCHIATRIC SERVICES S CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 SKOKIE BLVD
NORTHBROOK IL
60062-1612
US

IV. Provider business mailing address

8926 N GREENWOOD AVE SUITE 167
NILES IL
60714-5163
US

V. Phone/Fax

Practice location:
  • Phone: 847-498-9320
  • Fax:
Mailing address:
  • Phone: 847-685-9326
  • Fax: 847-685-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number036091974
License Number StateIL

VIII. Authorized Official

Name: DR. NICHOLAS PAPANOS
Title or Position: PHYSICIAN
Credential:
Phone: 847-685-9326