Provider Demographics
NPI:1952937104
Name:BESPOKE PSYCHIATRY
Entity Type:Organization
Organization Name:BESPOKE PSYCHIATRY
Other - Org Name:BESPOKE PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HNATIW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-241-1495
Mailing Address - Street 1:1203 W AUGUSTA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-4327
Mailing Address - Country:US
Mailing Address - Phone:773-248-2255
Mailing Address - Fax:
Practice Address - Street 1:1203 W AUGUSTA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4327
Practice Address - Country:US
Practice Address - Phone:773-248-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty