Provider Demographics
NPI:1326661802
Name:PSYCHMED CLINIC INC
Entity Type:Organization
Organization Name:PSYCHMED CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ZAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-817-5129
Mailing Address - Street 1:2159 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2307
Mailing Address - Country:US
Mailing Address - Phone:508-979-5557
Mailing Address - Fax:508-979-5955
Practice Address - Street 1:2159 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2307
Practice Address - Country:US
Practice Address - Phone:508-979-5557
Practice Address - Fax:508-979-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty