Healthcare Provider Details

I. General information

NPI: 1134083215
Provider Name (Legal Business Name): CATER PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 BRIDGEVIEW COURT ST
ST. CHARLES IL
60174
US

IV. Provider business mailing address

5343 BELLEVILLE CROSSING ST
BELLEVILLE IL
62226-3108
US

V. Phone/Fax

Practice location:
  • Phone: 856-515-2033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THAMIR RIAD KHADER
Title or Position: CEO/FOUNDER
Credential: MD
Phone: 856-515-2033