MEDICARE: DR. PAULA MADELYN GORLITZ PHD

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	072003086	IL

General Provider Information

NPI Number	:	1306005814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA MADELYN GORLITZ PHD

Provider Business Mailing Address
First Line	:	233 EAST WACKER DRIVE
Second Line	:	SUITE 1302
City	:	CHICAGO
State	:	IL
Zip	:	60601-5104
Country	:	US
Telephone Number	:	312-203-9296
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 E WACKER DR
Second Line	:	SUITE 1302
City	:	CHICAGO
State	:	IL
Zip	:	60601-5104
Country	:	US
Telephone Number	:	312-203-9296
Fax Number	:	847-251-7974

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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