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General NPI Number Information
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NPI Number | 1023799103
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Entity Type | Organization
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Legal Business Name | INTERSECTIONAL PSYCHIATRY PLLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 2334 W LAWRENCE AVE STE 221
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City | CHICAGO
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State | IL
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Zip | 60625-1030
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Country | US
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Telephone | 312-535-9614
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Fax |
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Provider Business Mailing Address
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Address Line | 2334 W LAWRENCE AVE STE 221
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City | CHICAGO
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State | IL
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Zip | 60625-1030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. DAVID RALPH MICHAEL
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Credential | DO
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Telephone | 312-535-9614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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