NPI 1215194519

Mathers Clinic, LLC

Organisation Child & Adolescent Psychiatry Physician Rockford, IL

Practice location

Address: 5804 Elaine Dr, Rockford, IL 61108-2435
Phone: (815) 397-7654
Fax: (815) 397-2712
Mailing address: 8420 W Bryn Mawr Ave Suite 620, Chicago, IL 60631-3479

Authorised official

Name: Ramesh Babu Vemuri
Title: Vice President
Phone: (815) 397-7654

Registered specialties

Child & Adolescent Psychiatry Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2084P0804X Licence 36039266 (IL)

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Registry record

NPI: 1215194519
Entity type: Organization
NPI issued: 22 May 2008
Record last updated: 22 May 2008

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.