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General NPI Number Information
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NPI Number | 1346066883
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Entity Type | Organization
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Legal Business Name | PSYCHPROMD LLC
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Dates
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Enumeration Date | 11/30/2024
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 1650 MOON LAKE BLVD
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-1010
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Country | US
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Telephone | 312-599-1948
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Fax |
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Provider Business Mailing Address
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Address Line | 836 S ARLINGTON HEIGHTS RD STE 342
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3667
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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 | OWNER
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Name | SHAUN WOOD
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Credential |
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Telephone | 312-599-1948
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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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