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General NPI Number Information
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NPI Number | 1497252449
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Entity Type | Organization
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Legal Business Name | V COVINGTON, LLC
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 2615 WASHINGTON ST
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City | WAUKEGAN
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State | IL
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Zip | 60085-4980
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Country | US
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Telephone | 855-990-1900
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Fax | 847-249-8747
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Provider Business Mailing Address
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Address Line | 2615 WASHINGTON ST
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City | WAUKEGAN
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State | IL
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Zip | 60085-4980
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Country | US
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Telephone | 855-990-1900
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Fax | 847-249-8747
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Authorized Official
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Title or Position | MANAGER
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Name | RICHARD ALLEN KRESCH
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Credential | M.D.
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Telephone | 212-243-5565
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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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