Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071.009445 | IL |
Y | 103TC0700X | Clinical Psychologist | 071.009445 | IL |
N | 103TC1900X | Counseling Psychologist | 3420-57 | WI |
NPI | 1003276957 |
---|---|
Provider Name | Michael Fung |
First Address | Chicago, IL 60612-3728 |
Second Address | Chicago, IL 60612-3728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2016 |
Last Update Date | 07/12/2016 |