MEDICARE: BEHAVIORAL MEDICINE INSTITUTE

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	103TC0700X	Clinical Psychologist	071.007323	IL

General Provider Information

NPI Number	:	1568751725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL MEDICINE INSTITUTE

Provider Business Mailing Address
First Line	:	875 N MICHIGAN AVE STE 3100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-1962
Country	:	US
Telephone Number	:	312-998-1015
Fax Number	:	312-794-7801

Provider Business Practice Location Address
First Line	:	875 N MICHIGAN AVE STE 3100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-1962
Country	:	US
Telephone Number	:	312-998-1015
Fax Number	:	312-794-7801

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. GRACE KIM HUH
Credential	:
Telephone Number	:	312-998-1015

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	02/23/2024

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