Provider Demographics
NPI:1902102890
Name:DR MICHAEL S MALING LTD
Entity Type:Organization
Organization Name:DR MICHAEL S MALING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-780-4900
Mailing Address - Street 1:660 LASALLE PLACE
Mailing Address - Street 2:SUITE # 1A
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3575
Mailing Address - Country:US
Mailing Address - Phone:847-780-4900
Mailing Address - Fax:847-945-0853
Practice Address - Street 1:660 LASALLE PLACE
Practice Address - Street 2:SUITE 1A
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3575
Practice Address - Country:US
Practice Address - Phone:847-780-4900
Practice Address - Fax:847-945-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071 004554261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health