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General NPI Number Information
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NPI Number | 1992251672
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Entity Type | Individual
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Provider Name | MICHAEL QUANT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 847-688-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 W 35TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-1305
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Country | US
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Telephone | 773-247-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3400 - 57
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.009393
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License Number State | IL
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