MEDICARE: DR. ARNOLD MICHAEL ORDMAN 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	071-003381	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	016-73143	OTHER	IL	BLUE CROSS BLUE SHIELD
2	280609	OTHER	IL	VALUE OPTIONS
3	019-25-7000	OTHER	IL	MAGELLAN BEHAVIORAL HEALT
4	460-3568	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1194834309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARNOLD MICHAEL ORDMAN PH.D.

Provider Business Mailing Address
First Line	:	1755 W FLETCHER ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3023
Country	:	US
Telephone Number	:	773-549-7813
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 W FLETCHER ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3023
Country	:	US
Telephone Number	:	773-612-1895
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	05/20/2022

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