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General NPI Number Information
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NPI Number | 1518346170
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Entity Type | Organization
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Legal Business Name | 83RD PROFESSIONAL GROUP LLC
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 6723 KINGREY HIGHWAY
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City | WILLOWBROOK
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State | IL
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Zip | 60527
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Country | US
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Telephone | 630-850-0600
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Fax | 630-850-0608
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Provider Business Mailing Address
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Address Line | 6723 KINGREY HIGHWAY
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City | WILLOWBROOK
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State | IL
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Zip | 60527
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Country | US
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Telephone | 630-850-0600
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Fax | 630-850-0608
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | TALAT GHAUS
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Credential | MD
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Telephone | 630-234-4895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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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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