MEDICARE: PSYCHIATRIC CONSULTANTS OF ILLINOIS

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	2084P0805X	Geriatric Psychiatry Physician

General Provider Information

NPI Number	:	1790713634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRIC CONSULTANTS OF ILLINOIS

Provider Business Mailing Address
First Line	:	2010 N HARLEM AVE
Second Line	:
City	:	NORRIDGE
State	:	IL
Zip	:	60706
Country	:	US
Telephone Number	:	708-452-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 N HARLEM AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-3119
Country	:	US
Telephone Number	:	708-452-4443
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YOGI AHLUWALIA
Credential	:	MD
Telephone Number	:	708-452-4443

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	08/22/2020

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