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General NPI Number Information
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NPI Number | 1225775018
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Entity Type | Organization
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Legal Business Name | PRESTIGE PSYCHIATRY 1 LLC
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Dates
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Enumeration Date | 05/13/2022
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 1413 S ADDISON AVE
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City | LOMBARD
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State | IL
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Zip | 60148-4118
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Country | US
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Telephone | 630-520-4657
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 S ADDISON AVE
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City | LOMBARD
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State | IL
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Zip | 60148-4118
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Country | US
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Telephone | 630-520-4657
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHUJA UDDIN
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Credential | MD
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Telephone | 630-520-4657
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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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