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General NPI Number Information
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NPI Number | 1164047833
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Entity Type | Organization
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Legal Business Name | ADVANCED PSYCHIATRY CLINICS, S.C.
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 5519 N CUMBERLAND AVE STE 1016
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City | CHICAGO
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State | IL
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Zip | 60656-1480
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Country | US
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Telephone | 708-224-8840
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Fax | 773-594-7721
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Provider Business Mailing Address
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Address Line | 5519 N CUMBERLAND AVE STE 1016
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City | CHICAGO
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State | IL
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Zip | 60656-1480
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Country | US
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Telephone | 708-224-8840
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Fax | 773-594-7721
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAREK WALCZYK
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Credential | MD
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Telephone | 708-224-8840
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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 |
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License Number State |
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