Provider Demographics
NPI:1063161578
Name:EZ PSYCHIATRY AND MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:EZ PSYCHIATRY AND MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNANG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:708-574-8895
Mailing Address - Street 1:1130 S CANAL ST # 1373
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4907
Mailing Address - Country:US
Mailing Address - Phone:312-884-1714
Mailing Address - Fax:
Practice Address - Street 1:1130 S CANAL ST # 1373
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4907
Practice Address - Country:US
Practice Address - Phone:312-884-1714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty