Michael J Didomenico PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

071005762 Issued in IL

Legal business name

MICHAEL J DIDOMENICO PSYD

Practice address

3545 Lake Ave Ste 100
Wilmette, IL 60091-1058

Phone

(844) 251-1800

Fax

(847) 251-1866

NPI assigned

Apr 9, 2007

Last updated

Sep 22, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janeen Berrios

Title

Account Manager

Phone

(847) 770-6088

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charulatha Nagar, M.D.

  • Neurology Physician
  • Lake Forest, IL
  • NPI 1104810191
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316649600000",
    "number": "1417070152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 443",
            "city": "WINNETKA",
            "state": "IL",
            "postal_code": "600930443",
            "telephone_number": "847-770-6088",
            "fax_number": "847-562-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3545 LAKE AVE STE 100",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911058",
            "telephone_number": "844-251-1800",
            "fax_number": "847-251-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J DIDOMENICO PSYD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2011-09-22",
        "status": "A",
        "authorized_official_last_name": "BERRIOS",
        "authorized_official_first_name": "JANEEN",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "847-770-6088"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071005762",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "IL",
            "license": "071005762",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005762",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Metro Chicago Surgical Oncology LLC (MCSO Diagnostic Center)
• Morgan Mette
• Robin Metzler
• Mary Lynn Meyers, LCSW, MSW
• Michael G Clark DC SC
• Michael J Engelman DDS LTD
• Michael L Belba DC PC
• Bradley Franklin Miller
• Catherine Milner
• Ana Maria V Mitchell, L.AC

• Clinical Neuropsychologist in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Clinical Neuropsychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.