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General NPI Number Information
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NPI Number | 1083069595
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Entity Type | Organization
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Legal Business Name | SANDERS PSYCHIATRIC ASSOCIATES, LTD
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 2544 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-1537
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Country | US
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Telephone | 773-267-2622
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 101281
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City | CHICAGO
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State | IL
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Zip | 60610-8909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY SANDERS
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Credential | MD
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Telephone | 312-257-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036087433
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License Number State | IL
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