Healthcare Provider Details

I. General information

NPI: 1982993994
Provider Name (Legal Business Name): PSYCHOPHARMACOLOGY CLINICS OF AMERICA, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HARGER RD SUITE 415
OAK BROOK IL
60523-1805
US

IV. Provider business mailing address

1200 HARGER RD SUITE 415
OAK BROOK IL
60523-1805
US

V. Phone/Fax

Practice location:
  • Phone: 630-928-1000
  • Fax: 630-928-0020
Mailing address:
  • Phone: 630-928-1000
  • Fax: 630-928-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-082013
License Number StateIL

VIII. Authorized Official

Name: MOHAMMED Y ALAM
Title or Position: PRESIDENT
Credential: MD
Phone: 630-928-1000