Provider Demographics
NPI:1861779084
Name:DYNAMIC PSYCHIATRY LLC
Entity type:Organization
Organization Name:DYNAMIC PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-217-0155
Mailing Address - Street 1:147 N 2ND ST
Mailing Address - Street 2:SUITE #7
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3276
Mailing Address - Country:US
Mailing Address - Phone:815-217-0155
Mailing Address - Fax:815-217-0185
Practice Address - Street 1:147 N 2ND ST
Practice Address - Street 2:SUITE #7
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3276
Practice Address - Country:US
Practice Address - Phone:815-217-0155
Practice Address - Fax:815-217-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty