Provider Demographics
NPI:1831218775
Name:PEA INC
Entity type:Organization
Organization Name:PEA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-898-1031
Mailing Address - Street 1:3845 MCCOY DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4428
Mailing Address - Country:US
Mailing Address - Phone:630-898-1031
Mailing Address - Fax:630-898-0984
Practice Address - Street 1:3845 MCCOY DR
Practice Address - Street 2:SUITE 109
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4428
Practice Address - Country:US
Practice Address - Phone:630-898-1031
Practice Address - Fax:630-898-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211602Medicare ID - Type UnspecifiedGROUP PROVIDER NO.