Provider Demographics
NPI:1265509392
Name:CENTRAL IL PSYCHIATRIC ASSOCIATES, INC
Entity Type:Organization
Organization Name:CENTRAL IL PSYCHIATRIC ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-862-0064
Mailing Address - Street 1:405 KAYS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1979
Mailing Address - Country:US
Mailing Address - Phone:309-862-0064
Mailing Address - Fax:309-862-1542
Practice Address - Street 1:405 KAYS DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-862-0064
Practice Address - Fax:309-862-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL588330Medicare PIN