Provider Demographics
NPI:1326004938
Name:WASSERMAN, MICHAEL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8780 W GOLF ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-298-4590
Mailing Address - Fax:847-298-0635
Practice Address - Street 1:8780 W GOLF ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-298-4590
Practice Address - Fax:847-298-0635
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2021-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36399732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
740140Medicare ID - Type Unspecified
D12194Medicare UPIN