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NPI Code Detail

MEDICARE: DR. MICHAEL BRYAN IGARAVIDEZ PSY.D.

MEDICARE: DR. MICHAEL BRYAN IGARAVIDEZ 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
1103TC0700XClinical Psychologist071-006172IL

General Provider Information

NPI Number : 1497711782
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL BRYAN IGARAVIDEZ PSY.D.
Provider Business Mailing Address
First Line : 5550 TOUHY AVE STE 404
Second Line :
City : SKOKIE
State : IL
Zip : 60077-3227
Country : US
Telephone Number : 847-329-9210
Fax Number :
Provider Business Practice Location Address
First Line : 5550 TOUHY AVE STE 404
Second Line :
City : SKOKIE
State : IL
Zip : 60077-3227
Country : US
Telephone Number : 847-329-9210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 11/08/2023

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