Provider Demographics
NPI:1942225669
Name:GURSKY, DAVID M (PH D)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:GURSKY
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BAMBURG CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5243
Mailing Address - Country:US
Mailing Address - Phone:630-372-6599
Mailing Address - Fax:630-372-6697
Practice Address - Street 1:1240 BAMBURG CT
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5243
Practice Address - Country:US
Practice Address - Phone:630-372-6599
Practice Address - Fax:630-372-6697
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
946942Medicare ID - Type Unspecified