MEDICARE: DR. DAVID MICHAEL COMP RAKOFSKY 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	103TC0700X	Clinical Psychologist	20041938A	IN
2	103TC0700X	Clinical Psychologist	071006828	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IL5309001	OTHER	IL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000353109	OTHER	IN	ANTHEM BCBS

General Provider Information

NPI Number	:	1467444604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL COMP RAKOFSKY PSY.D.

Provider Business Mailing Address
First Line	:	1011 W WELLINGTON AVE # 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4325
Country	:	US
Telephone Number	:	312-384-1940
Fax Number	:	773-423-8444

Provider Business Practice Location Address
First Line	:	1011 W WELLINGTON AVE # 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4325
Country	:	US
Telephone Number	:	312-384-1940
Fax Number	:	773-423-8444

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	09/10/2020

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Directions to “ DR. DAVID MICHAEL COMP RAKOFSKY PSY.D.” Practice Location

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