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General NPI Number Information
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NPI Number | 1295270742
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Entity Type | Organization
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Legal Business Name | INSIGHT:EATING DISORDERS, WEIGHT MANAGEMENT AND PSYCHOLOGICAL CENTERS
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN AVE SUITE 1900
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City | CHICAGO
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State | IL
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Zip | 60601-3901
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Country | US
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Telephone | 312-540-9995
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Fax |
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Provider Business Mailing Address
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Address Line | 333 N MICHIGAN AVE SUITE 1900
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City | CHICAGO
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State | IL
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Zip | 60601-3901
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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 | SENIOR DIRECTOR
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Name | NEVILA MCDOUGAL
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Credential |
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Telephone | 773-321-2757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036-139143
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License Number State | IL
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