Provider Demographics
NPI:1295744480
Name:STONE, MICHAEL E (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:STONE
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 1:5250 OLD ORCHARD RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4460
Mailing Address - Country:US
Mailing Address - Phone:847-966-0166
Mailing Address - Fax:224-534-7630
Practice Address - Street 1:5250 OLD ORCHARD RD
Practice Address - Street 2:STE. 300
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4460
Practice Address - Country:US
Practice Address - Phone:847-966-0166
Practice Address - Fax:847-534-7630
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002933103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001672830OtherBLUE CROSS BLUE SHIELD