MEDICARE: FAMILY PSYCHIATRY PRACTICE, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician		IL

General Provider Information

NPI Number	:	1083819056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PSYCHIATRY PRACTICE, LTD.

Provider Business Mailing Address
First Line	:	PO BOX 24
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-0024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3295 N ARLINGTON HEIGHTS RD
Second Line	:	SUITE 102,
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1565
Country	:	US
Telephone Number	:	847-392-7400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ART POGRE
Credential	:
Telephone Number	:	847-790-6757

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	10/18/2007

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