Healthcare Provider Details

I. General information

NPI: 1912374380
Provider Name (Legal Business Name): MICHAEL LLOYD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 N MARINE DR SECOND FLOOR
CHICAGO IL
60613-1744
US

IV. Provider business mailing address

4343 N CLARENDON AVE UNIT 1008
CHICAGO IL
60613-2698
US

V. Phone/Fax

Practice location:
  • Phone: 847-886-4602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149017910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: