Provider Demographics
NPI:1336475003
Name:R A CLINIC FOR PSYCHIATRIC CARE LLC
Entity Type:Organization
Organization Name:R A CLINIC FOR PSYCHIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-770-3120
Mailing Address - Street 1:3147 TREESDALE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564
Mailing Address - Country:US
Mailing Address - Phone:630-753-9316
Mailing Address - Fax:630-753-9316
Practice Address - Street 1:3147 TREESDALE CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4609
Practice Address - Country:US
Practice Address - Phone:630-753-9316
Practice Address - Fax:630-753-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104198283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH30497Medicare UPIN