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AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP NPI 1083841076


NPI Information

NPI: 1083841076
Provider Name: AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP
Classification: Psychologist - 103TP0016X
Entity Type: Organization

Specialization: Prescribing (Medical)

Address:
8311 W ROOSEVELT RD
FOREST PARK, IL
ZIP 60130
Phone: (708) 209-4150
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AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP is a prescribing (medical) psychologist in Forest Park, IL. The provider is a licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended. AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP NPI is 1083841076. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

8311 W ROOSEVELT RD
FOREST PARK, IL
ZIP 60130
Phone: (708) 209-4150

The provider's authorized official is Michael Nelson .
The authorized official title is Cfo and has the following contact phone number (708) 209-4156.

The enumeration date for this NPI number is 6/17/2009 and was last updated on 6/17/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TP0016XPsychologistPrescribing (Medical)ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1144009MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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