MEDICARE: DR. MARK AGHAKHAN PSY.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	071-007235	IL
2	103TC0700X	Clinical Psychologist	071007235	IL
3	103T00000X	Psychologist

General Provider Information

NPI Number	:	1295843381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK AGHAKHAN PSY.D.

Provider Business Mailing Address
First Line	:	3653 N SPAULDING AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4424
Country	:	US
Telephone Number	:	773-425-2161
Fax Number	:

Provider Business Practice Location Address
First Line	:	3653 N SPAULDING AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4424
Country	:	US
Telephone Number	:	773-425-2161
Fax Number	:

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	09/19/2024

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