Provider Demographics
NPI:1356381529
Name:AISENBERG, MICHAEL (PSYD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:AISENBERG
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 1:10024 SKOKIE BLVD
Mailing Address - Street 2:SUITE #312
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-9944
Mailing Address - Country:US
Mailing Address - Phone:847-602-1380
Mailing Address - Fax:224-233-1033
Practice Address - Street 1:10024 SKOKIE BLVD
Practice Address - Street 2:SUITE #312
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-9944
Practice Address - Country:US
Practice Address - Phone:847-602-1380
Practice Address - Fax:224-233-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216038Medicare PIN