Provider Demographics
NPI:1891905436
Name:DVORKIN, LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:DVORKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1440 RENAISSANCE DR
Mailing Address - Street 2:320
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1356
Mailing Address - Country:US
Mailing Address - Phone:847-759-9110
Mailing Address - Fax:847-759-9440
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:320
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:847-759-9110
Practice Address - Fax:847-759-9440
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003853103G00000X
IL071.008864103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist