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NPI Code Detail

MEDICARE: BESPOKE PSYCHIATRY

MEDICARE: BESPOKE PSYCHIATRY
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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1952937104
Entity Type Code : Organization
Provider Name (Legal Business Name) : BESPOKE PSYCHIATRY
Provider Business Mailing Address
First Line : 1203 W AUGUSTA BLVD STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60642-4327
Country : US
Telephone Number : 773-248-2255
Fax Number :
Provider Business Practice Location Address
First Line : 1203 W AUGUSTA BLVD STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60642-4327
Country : US
Telephone Number : 773-248-2255
Fax Number :
Authorized Official
Title or Position : ACCOUNT MANAGER
Name : MARTHA C HNATIW
Credential :
Telephone Number : 630-241-1495
Provider Enumeration Date : 03/19/2020
Last Update Date : 02/02/2022

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Directions to “BESPOKE PSYCHIATRY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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