Provider Demographics
NPI:1972610285
Name:OLER, ISRAEL DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:DAVID
Last Name:OLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:OLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:14 CHICORY LN
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3544
Mailing Address - Country:US
Mailing Address - Phone:847-951-2570
Mailing Address - Fax:847-520-9511
Practice Address - Street 1:1020 MILWAUKEE AVE
Practice Address - Street 2:SUITE 153
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3513
Practice Address - Country:US
Practice Address - Phone:847-951-2570
Practice Address - Fax:847-520-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004932532OtherBLUE CROSS BLUE SHIELD
IL213166Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION N