MEDICARE: DR. MICHAEL J TANSEY PH.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	071-002506	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071-002506	OTHER	IL	STATE LICENSE
2	36-3173071	OTHER	IL	TAX ID

General Provider Information

NPI Number	:	1629199567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J TANSEY PH.D.

Provider Business Mailing Address
First Line	:	151 N MICHIGAN AVE
Second Line	:	SUITE 2119
City	:	CHICAGO
State	:	IL
Zip	:	60601-7506
Country	:	US
Telephone Number	:	312-729-5225
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 N MICHIGAN AVE
Second Line	:	SUITE 2119
City	:	CHICAGO
State	:	IL
Zip	:	60601-7506
Country	:	US
Telephone Number	:	312-729-5225
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	11/25/2009

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Directions to “ DR. MICHAEL J TANSEY PH.D.” Practice Location

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