Provider Demographics
NPI:1861632192
Name:CHICAGO DEPRESSION AND ANXIETY SPECIALISTS, SC
Entity Type:Organization
Organization Name:CHICAGO DEPRESSION AND ANXIETY SPECIALISTS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-895-4431
Mailing Address - Street 1:330 W DIVERSEY PKWY APT 2707
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6209
Mailing Address - Country:US
Mailing Address - Phone:312-985-4431
Mailing Address - Fax:
Practice Address - Street 1:330 W DIVERSEY PKWY APT 2707
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6209
Practice Address - Country:US
Practice Address - Phone:312-985-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0426194640360767212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty