Healthcare Provider Details

I. General information

NPI: 1902102890
Provider Name (Legal Business Name): DR MICHAEL S MALING LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 LASALLE PLACE SUITE 1A
HIGHLAND PARK IL
60035-3575
US

IV. Provider business mailing address

660 LASALLE PLACE SUITE # 1A
HIGHLAND PARK IL
60035-3575
US

V. Phone/Fax

Practice location:
  • Phone: 847-780-4900
  • Fax: 847-945-0853
Mailing address:
  • Phone: 847-780-4900
  • Fax: 847-945-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number071 004554
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL S MALING
Title or Position: CLLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 847-780-4900