MEDICARE: DR. ARI GRAFF 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	071007163	IL

General Provider Information

NPI Number	:	1699917443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARI GRAFF PSY.D.

Provider Business Mailing Address
First Line	:	728 W JACKSON BLVD
Second Line	:	APT. 711
City	:	CHICAGO
State	:	IL
Zip	:	60661-5490
Country	:	US
Telephone Number	:	708-828-0970
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 E 50TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2905
Country	:	US
Telephone Number	:	708-828-0970
Fax Number	:

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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