MEDICARE: MICHAL ROSENBERG 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	071011073	IL

General Provider Information

NPI Number	:	1649054784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAL ROSENBERG PSY.D.

Provider Business Mailing Address
First Line	:	1623 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2835 N SHEFFIELD AVE STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5084
Country	:	US
Telephone Number	:	773-788-6870
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/30/2025

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