Michael William Mangis, PH.D.
Individual provider Active NPI Psychologist · Elburn, IL
NPI 1063405249 · NPPES record last updated Jan 31, 2008
Key facts
- NPI
- 1063405249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- Practice address
- 106 W Pierce St
Elburn, IL 60119-8201 - Phone
- (630) 365-0899
- Fax
- (630) 365-9150
- NPI assigned
- Aug 23, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071004331 | IL | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Rural Psychology | Past |
Accepting new patients | |
| Foroutan & Associates SC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | IL | Yes |
Addresses
Primary practice location
106 W Pierce St
Elburn, IL 60119-8201
Mailing address
106 W Pierce St
Elburn, IL 60119-8201
Phone (630) 365-0899
Other providers in Elburn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.