Provider Demographics
NPI:1518346170
Name:83RD PROFESSIONAL GROUP LLC
Entity Type:Organization
Organization Name:83RD PROFESSIONAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TALAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-234-4895
Mailing Address - Street 1:6723 KINGREY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:630-850-0600
Mailing Address - Fax:630-850-0608
Practice Address - Street 1:6723 KINGREY HIGHWAY
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:630-850-0600
Practice Address - Fax:630-850-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty