Provider Demographics
NPI:1770638686
Name:DECATUR PSYCHIATRY LTD
Entity Type:Organization
Organization Name:DECATUR PSYCHIATRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJUM
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-809-0429
Mailing Address - Street 1:363 S MAIN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1492
Mailing Address - Country:US
Mailing Address - Phone:217-809-0429
Mailing Address - Fax:217-422-0041
Practice Address - Street 1:363 S MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1492
Practice Address - Country:US
Practice Address - Phone:217-809-0429
Practice Address - Fax:217-422-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361058482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105848Medicaid
IL213272OtherMEDICARE