MEDICARE: DR. MICHAEL J PURCELL PSYD

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	071006908	IL

General Provider Information

NPI Number	:	1720132434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J PURCELL PSYD

Provider Business Mailing Address
First Line	:	6910 W DICKENS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-3327
Country	:	US
Telephone Number	:	773-796-0747
Fax Number	:

Provider Business Practice Location Address
First Line	:	6832 W NORTH AVE
Second Line	:	SUITE 4B
City	:	CHICAGO
State	:	IL
Zip	:	60707-4430
Country	:	US
Telephone Number	:	773-796-0747
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	11/19/2013

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