Provider Demographics
NPI:1255451084
Name:MAURICE SOLODKY PHD P.C.
Entity type:Organization
Organization Name:MAURICE SOLODKY PHD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLODKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-301-1968
Mailing Address - Street 1:PO BOX 388320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8320
Mailing Address - Country:US
Mailing Address - Phone:773-767-4600
Mailing Address - Fax:773-767-8320
Practice Address - Street 1:1034 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3002
Practice Address - Country:US
Practice Address - Phone:312-301-1968
Practice Address - Fax:708-660-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001672960OtherBLUE SHIELD
IL788231Medicare ID - Type Unspecified