1528188018 NPI number — DR. CRAIG CARLTON MCCALL PSY.D.

Table of content: DR. CRAIG CARLTON MCCALL PSY.D. (NPI 1528188018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528188018 NPI number — DR. CRAIG CARLTON MCCALL PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCALL
Provider First Name:
CRAIG
Provider Middle Name:
CARLTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528188018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 S WACKER DR
Provider Second Line Business Mailing Address:
SUITE 2200
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60606-7413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-263-1018
Provider Business Mailing Address Fax Number:
312-466-5601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 WAUKEGAN RD
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60025-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-263-1018
Provider Business Practice Location Address Fax Number:
312-466-5601
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071005951 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043459324 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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