Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | IL | |
Y | 103TC0700X | Clinical Psychologist | IL |
NPI | 1003917006 |
---|---|
Provider Name | Dr. Mark I Oberlander |
First Address | Evanston, IL 60201-3875 |
Second Address | Evanston, IL 60201-3875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001672047 | (02) |