Provider Demographics
NPI:1508858093
Name:PRIMARY CARE & PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:PRIMARY CARE & PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANIW-GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:630-788-2131
Mailing Address - Street 1:132 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:164 DIVISION ST
Practice Address - Street 2:STE 617
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5587
Practice Address - Country:US
Practice Address - Phone:630-788-2131
Practice Address - Fax:630-237-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty