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General NPI Number Information
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NPI Number | 1861779084
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Entity Type | Organization
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Legal Business Name | DYNAMIC PSYCHIATRY LLC
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 147 N 2ND ST SUITE #7
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City | DEKALB
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State | IL
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Zip | 60115-3276
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Country | US
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Telephone | 815-217-0155
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Fax | 815-217-0185
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Provider Business Mailing Address
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Address Line | 147 N 2ND ST SUITE #7
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City | DEKALB
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State | IL
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Zip | 60115-3276
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Country | US
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Telephone | 815-217-0155
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Fax | 815-217-0185
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAMON MARQUEZ
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Credential | MD
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Telephone | 815-217-0155
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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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