Provider Demographics
NPI:1073546008
Name:MARVIN J PITLUK & ASSOCIATES LTD
Entity Type:Organization
Organization Name:MARVIN J PITLUK & ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PITLUK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-446-1985
Mailing Address - Street 1:477 HAWTHORN LN
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4247
Mailing Address - Country:US
Mailing Address - Phone:847-446-1985
Mailing Address - Fax:
Practice Address - Street 1:477 HAWTHORN LN
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-4247
Practice Address - Country:US
Practice Address - Phone:847-446-1985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060000781103T00000X
071000272103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01672044OtherBLUE CROSS BLUE SHIELD
IL506820Medicare PIN