Provider Demographics
NPI:1679253140
Name:VITAL BALANCE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:VITAL BALANCE PSYCHIATRY PLLC
Other - Org Name:VITAL BALANCE PSYCHIATRY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-600-8533
Mailing Address - Street 1:1100 CENTRAL AVE UNIT F-3
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 CENTRAL AVE UNIT F-3
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2666
Practice Address - Country:US
Practice Address - Phone:312-600-8533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty