MEDICARE: DR. AUGUST J CWIK PSY.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	103TP0814X	Psychoanalysis Psychologist	071003032	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01672990	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1457333809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUGUST J CWIK PSY.D.

Provider Business Mailing Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE 1900
City	:	CHICAGO
State	:	IL
Zip	:	60602-3402
Country	:	US
Telephone Number	:	312-346-6638
Fax Number	:	847-398-6348

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE 1900
City	:	CHICAGO
State	:	IL
Zip	:	60602-3402
Country	:	US
Telephone Number	:	312-346-6638
Fax Number	:	847-398-6348

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/07/2010

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