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1447125364 NPI number — MIDWEST FUNCTIONAL PSYCHIATRY

NPI Number: 1447125364
Health Care Provider/Practitioner: MIDWEST FUNCTIONAL PSYCHIATRY

Information about “1447125364” NPI (MIDWEST FUNCTIONAL PSYCHIATRY) exists in 1447125364 in HTML format HTML  |  1447125364 in plain Text format TXT  |  1447125364 in PDF (Portable Document Format) PDF  |  1447125364 in an XML format XML  formats.

NPI Number : 1447125364 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1447125364",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MIDWEST FUNCTIONAL PSYCHIATRY",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "404 W BOUGHTON RD STE A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOLINGBROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60440-1898",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-885-0760",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "404 W BOUGHTON RD STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOLINGBROOK",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60440-1898",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-885-0760",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/09/2025",
    "LastUpdateDate": "11/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SIDDIQUI",
    "AuthorizedOfficialFirstName": "MOHAMMED",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "630-290-2246",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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