MEDICARE: MICHAEL COLOMBATTO 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
1	103TC0700X	Clinical Psychologist	071-005566	IL

General Provider Information

NPI Number	:	1629441357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL COLOMBATTO PSY.D.

Provider Business Mailing Address
First Line	:	600 S DEARBORN ST APT 1211
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1895
Country	:	US
Telephone Number	:	312-859-6512
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S DEARBORN ST APT 1211
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1895
Country	:	US
Telephone Number	:	312-859-6512
Fax Number	:

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

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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