Provider Demographics
NPI:1578693180
Name:MICHAEL R BINDER
Entity Type:Organization
Organization Name:MICHAEL R BINDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-691-2581
Mailing Address - Street 1:767 PARK AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2400
Mailing Address - Country:US
Mailing Address - Phone:262-691-2581
Mailing Address - Fax:
Practice Address - Street 1:767 PARK AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2400
Practice Address - Country:US
Practice Address - Phone:262-691-2581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-96922103T00000X
WI30357-020103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31798800Medicaid
WI31798800Medicaid
ILF21796Medicare UPIN
IL205916Medicare ID - Type Unspecified