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NPI Code Detail

MEDICARE: DR. MARK BRENZINGER PSY.D.

MEDICARE: DR. MARK BRENZINGER 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 PsychologistIL

General Provider Information

NPI Number : 1508050766
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK BRENZINGER PSY.D.
Provider Business Mailing Address
First Line : 869 E SCHAUMBURG RD
Second Line : SUITE 252
City : SCHAUMBURG
State : IL
Zip : 60194-3654
Country : US
Telephone Number : 847-344-7472
Fax Number :
Provider Business Practice Location Address
First Line : 1100 S HAMILTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60612-4207
Country : US
Telephone Number : 312-433-7377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2007
Last Update Date : 08/30/2007

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