Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | IL | |
N | 103T00000X | Psychologist | IL | |
N | 103G00000X | Clinical Psychologist | IL | |
N | 103TC0700X | Clinical Psychologist | IL | |
N | 103TH0100X | Health Service | IL |
NPI | 1114069093 |
---|---|
Provider Name | Dr. Marc I Oster |
First Address | Highland Park, IL 60035-3104 |
Second Address | Deerfield, IL 60015-4909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |