Provider Demographics
NPI:1326159229
Name:DIAGNOSTIC PSYCHIATRY SC
Entity Type:Organization
Organization Name:DIAGNOSTIC PSYCHIATRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RISDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-679-3079
Mailing Address - Street 1:4711 W GOLF RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-679-3079
Mailing Address - Fax:847-679-8340
Practice Address - Street 1:4711 W GOLF RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-679-3079
Practice Address - Fax:847-679-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204453Medicare ID - Type Unspecified
IL204452Medicare ID - Type Unspecified