Provider Demographics
NPI:1700893237
Name:SANDERS, PAUL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3647 RADCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4215
Mailing Address - Country:US
Mailing Address - Phone:847-302-7682
Mailing Address - Fax:312-277-5360
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1704
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-332-6091
Practice Address - Fax:312-332-6508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001672882OtherBLUE CROSS PROVIDER NUMBE
IL363522880OtherFEDERAL TAX I.D. NUMBER
IL071002781OtherPROFESSIONAL LICENSE