Doctor Name: | DR. MARK I OBERLANDER |
NPI Number: | 1003917006 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | |
Business Practice Address: | 708 Church St 223 Evanston, IL - 602013875 |
Business Phone Number: | 8474756666 |
Business Fax Number: | |
Mailing Address: | 708 Church St, 223 EVANSTON |
State: | IL |
Postal Code: | 602013875 |
Phone Number: | 8474756666 |
Fax Number: | |
NPI Enumeration Date: | 09/25/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |