Healthcare Provider Details

I. General information

NPI: 1396317111
Provider Name (Legal Business Name): PSYCHIATRY PHYSICIANS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 MIDWEST RD STE 202
OAK BROOK IL
60523-1368
US

IV. Provider business mailing address

2021 MIDWEST RD STE 202
OAK BROOK IL
60523-1368
US

V. Phone/Fax

Practice location:
  • Phone: 331-234-7287
  • Fax: 331-204-0796
Mailing address:
  • Phone: 331-234-7287
  • Fax: 331-204-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EVAN OWEN FOSTER DERANJA
Title or Position: PARTNER
Credential: MD
Phone: 331-222-7985