Provider Demographics
NPI:1447286661
Name:DIAGNOSTIC AND DEVELOPMENTAL CENTER
Entity type:Organization
Organization Name:DIAGNOSTIC AND DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-480-7880
Mailing Address - Street 1:1535 LAKE COOK RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1447
Mailing Address - Country:US
Mailing Address - Phone:847-480-7880
Mailing Address - Fax:847-480-7884
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1447
Practice Address - Country:US
Practice Address - Phone:847-480-7880
Practice Address - Fax:847-480-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X, 2084P0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental DisabilitiesGroup - Multi-Specialty