Provider Demographics
NPI:1942063862
Name:INTERVENTIONAL PSYCHIATRIC CENTER OF NORTH AMERICA
Entity Type:Organization
Organization Name:INTERVENTIONAL PSYCHIATRIC CENTER OF NORTH AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ELMAADAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-457-0711
Mailing Address - Street 1:51260 PEBBLE BEACH CT
Mailing Address - Street 2:PEBBLE BEACH CT.
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6551
Mailing Address - Country:US
Mailing Address - Phone:502-457-0711
Mailing Address - Fax:
Practice Address - Street 1:108TH AVE, SUITE 215
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:502-457-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty