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General NPI Number Information
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NPI Number | 1619951860
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHIATRIC EVALUATION AND TREATMENT CENTER
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 3633 W LAKE AVE SUITE 404
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City | GLENVIEW
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State | IL
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Zip | 60026-5805
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Country | US
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Telephone | 847-657-6007
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Fax | 847-657-6412
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Provider Business Mailing Address
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Address Line | 3633 W LAKE AVE SUITE 404
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City | GLENVIEW
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State | IL
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Zip | 60026-5805
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Country | US
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Telephone | 847-657-6007
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Fax | 847-657-6412
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT W BLOOM
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Credential | M.D.
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Telephone | 847-657-6007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 036-069110
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License Number State | IL
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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 | 036-069110
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License Number State | IL
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