Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003462821 |
---|---|
Provider Name | Mr. Michael Marek Maka |
First Address | Chicago, IL 60607 |
Second Address | Chicago, IL 60607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2019 |
Last Update Date | 16/08/2019 |