Healthcare Provider Details

I. General information

NPI: 1629181243
Provider Name (Legal Business Name): ASSOCIATES IN PSYCHIATRIC WELLNESS, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 GOLF RD SUITE 1200
SKOKIE IL
60076-1224
US

IV. Provider business mailing address

5251 GALITZ ST SUITE 304
SKOKIE IL
60077-3669
US

V. Phone/Fax

Practice location:
  • Phone: 224-217-9019
  • Fax: 847-770-4484
Mailing address:
  • Phone: 224-217-9019
  • Fax: 847-770-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK SHUKHMAN
Title or Position: GEN PARTNER
Credential: MD
Phone: 224-217-9019