MEDICARE: MR. MICHAEL ALAN BANGHART

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	101Y00000X	Counselor	178.002258	IL

General Provider Information

NPI Number	:	1336362631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ALAN BANGHART

Provider Business Mailing Address
First Line	:	824 S TAYLOR AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-1626
Country	:	US
Telephone Number	:	773-841-5150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 W WASHINGTON BLVD STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2127
Country	:	US
Telephone Number	:	773-645-8900
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	03/12/2025

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