| 83rd Professional Group Llc | |
|
6723 Kingrey Highway Willowbrook IL 60527 | |
| (630) 850-0600 | |
| (630) 850-0608 |
| Full Name | 83rd Professional Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6723 Kingrey Highway, Willowbrook, Illinois |
| Authorized Official Name and Position | Talat Ghaus (OWNER/ MANAGER) |
| Authorized Official Contact | 6302344895 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 83rd Professional Group Llc 6723 Kingrey Highway Willowbrook IL 60527 Ph: (630) 850-0600 | 83rd Professional Group Llc 6723 Kingrey Highway Willowbrook IL 60527 Ph: (630) 850-0600 |
| NPI Number | 1518346170 |
|---|---|
| Provider Enumeration Date | 05/28/2015 |
| Last Update Date | 09/18/2015 |
| Medicare PECOS PAC ID | 0042527681 |
|---|---|
| Medicare Enrollment ID | O20150915002322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518346170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Talat Ghaus |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689623472 PECOS PAC ID: 1557340874 Enrollment ID: I20040719001145 |
| Provider Name | Annette M Ochs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952702060 PECOS PAC ID: 6305164666 Enrollment ID: I20150416001499 |
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