MEDICARE: DR. DAVID MICHAEL BROOKS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 20877	CA
2	103TC0700X	Clinical Psychologist	071.009978	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	W20435	OTHER	CA	MEDICARE GROUP ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174503403	OTHER	CA	CIGNA HEALTHCARE/CBH
2	1174503403	OTHER	CA	UNITED HEALTHCARE
3	1143651	OTHER		CAQH IDENTIFIER
4	OPL208770	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1174503403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL BROOKS PH.D.

Provider Business Mailing Address
First Line	:	3800 N LAKE SHORE DR # 5E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3301
Country	:	US
Telephone Number	:	310-498-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 N LAKE SHORE DR # 5E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3301
Country	:	US
Telephone Number	:	310-498-0555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	08/10/2024

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Directions to “ DR. DAVID MICHAEL BROOKS PH.D.” Practice Location

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