NPI 1003056557

King Community Mental Health Center Corp

Organisation Neurology Physician Chicago, IL

Practice location

Address: 4455 S King Drive Suite 101, Chicago, IL 60653-3310
Phone: (773) 536-2700
Fax: (773) 751-2250

Authorised official

Name: Roueen Rafeyan
Title: Owner
Phone: (773) 536-2700

Registered specialties

Neurology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2084N0400X Licence 036089152 (IL)

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Registry record

NPI: 1003056557
Entity type: Organization
NPI issued: 24 Feb 2009
Record last updated: 25 Jun 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.