Healthcare Provider Details

I. General information

NPI: 1255343596
Provider Name (Legal Business Name): NEIL H PLISKIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S WOOD ST
CHICAGO IL
60612-4300
US

IV. Provider business mailing address

1101 SANDHURST CT
BUFFALO GROVE IL
60089-6822
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6217
  • Fax: 312-413-7856
Mailing address:
  • Phone:
  • Fax: 312-413-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071004204
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number071004204
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071004204
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: