MEDICARE: MUGEN PSYCHIATRY LLC

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

General Provider Information

NPI Number	:	1861146284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUGEN PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	3023 N CLARK ST STE 593
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5200
Country	:	US
Telephone Number	:	205-427-9243
Fax Number	:	314-405-9688

Provider Business Practice Location Address
First Line	:	3023 N CLARK ST STE 593
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5200
Country	:	US
Telephone Number	:	205-427-9243
Fax Number	:	314-405-9688

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. ALAN AKIRA
Credential	:	MD
Telephone Number	:	205-427-9243

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	02/07/2022

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