Healthcare Provider Details

I. General information

NPI: 1184772253
Provider Name (Legal Business Name): MICHAEL LOSOFF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SKOKIE BLVD STE 208
NORTHBROOK IL
60062-4033
US

IV. Provider business mailing address

910 SKOKIE BLVD STE 208
NORTHBROOK IL
60062-4033
US

V. Phone/Fax

Practice location:
  • Phone: 708-263-9655
  • Fax: 773-389-2352
Mailing address:
  • Phone: 708-263-9655
  • Fax: 773-389-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071-004947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: