Provider Demographics
NPI:1245249432
Name:PENDLER, PAUL B (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:PENDLER
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 1:405 N WABASH AVE UNIT 4905
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5692
Mailing Address - Country:US
Mailing Address - Phone:312-422-1280
Mailing Address - Fax:
Practice Address - Street 1:405 N WABASH AVE UNIT 4905
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5692
Practice Address - Country:US
Practice Address - Phone:312-422-1280
Practice Address - Fax:312-422-9339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL384650Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER