Provider Demographics
NPI:1467444604
Name:RAKOFSKY, DAVID MICHAEL COMP (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL COMP
Last Name:RAKOFSKY
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 1:1011 W WELLINGTON AVE # 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4325
Mailing Address - Country:US
Mailing Address - Phone:312-384-1940
Mailing Address - Fax:773-423-8444
Practice Address - Street 1:1011 W WELLINGTON AVE # 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4325
Practice Address - Country:US
Practice Address - Phone:312-384-1940
Practice Address - Fax:773-423-8444
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041938A103TC0700X
IL071006828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5309001OtherMEDICARE PTAN
IN200345070Medicaid
IN000000353109OtherANTHEM BCBS
ILIL5309001OtherMEDICARE PTAN