Provider Demographics
NPI:1851645964
Name:PILSEN PSYCHIATRIC CLINIC & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PILSEN PSYCHIATRIC CLINIC & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:VENOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-738-3355
Mailing Address - Street 1:1870 S BLUE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3013
Mailing Address - Country:US
Mailing Address - Phone:312-738-3355
Mailing Address - Fax:
Practice Address - Street 1:1870 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3013
Practice Address - Country:US
Practice Address - Phone:312-738-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty