Provider Demographics
NPI:1003462821
Name:MAKA, MICHAEL MAREK (PSYD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MAREK
Last Name:MAKA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W. JACKSON BLVD
Mailing Address - Street 2:SUITE 515
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607
Mailing Address - Country:US
Mailing Address - Phone:312-718-3336
Mailing Address - Fax:
Practice Address - Street 1:820 W. JACKSON BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:312-718-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist