MEDICARE: DR. PETER J. NEWMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071003377	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01673425	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144238643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER J. NEWMAN PH.D.

Provider Business Mailing Address
First Line	:	405 N. WABASH AVE
Second Line	:	SUITE 1814
City	:	CHICAGO
State	:	IL
Zip	:	60611-5661
Country	:	US
Telephone Number	:	312-245-9166
Fax Number	:	312-527-0849

Provider Business Practice Location Address
First Line	:	405 N. WABASH AVE
Second Line	:	SUITE 1814
City	:	CHICAGO
State	:	IL
Zip	:	60611-5661
Country	:	US
Telephone Number	:	312-245-9166
Fax Number	:	312-527-0849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/07/2015

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