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General NPI Number Information
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NPI Number | 1467655894
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Entity Type | Organization
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Legal Business Name | ILLINOIS INSTITUTE FOR INTEGRATIVE MENTAL HEALTH LTD
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 4770 N LINCOLN AVE STE 7
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City | CHICAGO
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State | IL
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Zip | 60625-1056
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Country | US
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Telephone | 312-342-0312
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W SUPERIOR ST APT 504
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City | CHICAGO
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State | IL
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Zip | 60610-7655
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Country | US
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Telephone | 312-342-0312
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELDIN DZUDZA
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Credential | MD
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Telephone | 312-342-0312
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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 | 036100514
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License Number State | IL
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