Provider Demographics
NPI:1114020757
Name:PROFESSSIONAL HEALTH ASSOCIATES LTD.
Entity Type:Organization
Organization Name:PROFESSSIONAL HEALTH ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SINIBALDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-923-7880
Mailing Address - Street 1:12255 S. 80TH AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-923-7880
Mailing Address - Fax:
Practice Address - Street 1:12255 S. 80TH AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-7880
Practice Address - Fax:708-923-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0991516762OtherBLUE CROSS BLUE SHEILD
IL983900Medicare ID - Type Unspecified
IL242810Medicare ID - Type Unspecified