| Illinois Professionals Health Program, Llc | |
|
701 Lee St Ste 125 Des Plaines IL 60016-4539 | |
| (847) 892-7910 | |
| (847) 892-7911 |
| Full Name | Illinois Professionals Health Program, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 701 Lee St Ste 125, Des Plaines, Illinois |
| Authorized Official Name and Position | Cynthia Lee Gordon (MEMBER MANAGER) |
| Authorized Official Contact | 8478927910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Professionals Health Program, Llc 701 Lee St Ste 125 Des Plaines IL 60016-4539 Ph: (847) 892-7910 | Illinois Professionals Health Program, Llc 701 Lee St Ste 125 Des Plaines IL 60016-4539 Ph: (847) 892-7910 |
| NPI Number | 1760907133 |
|---|---|
| Provider Enumeration Date | 08/07/2017 |
| Last Update Date | 05/23/2023 |
| Certification Date | 05/23/2023 |
| Medicare PECOS PAC ID | 1850649526 |
|---|---|
| Medicare Enrollment ID | O20180813002057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760907133 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Cynthia L Gordon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992961643 PECOS PAC ID: 7517012347 Enrollment ID: I20090901000049 |
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