Mark Gregory Iszak, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301014853 Issued in MI

Practice address

30150 Telegraph Rd Ste 245
Bingham Farms, MI 48025

Phone

(800) 693-1916

Fax

(248) 605-3525

NPI assigned

Sep 9, 2011

Last updated

Sep 20, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kathryn Miller PHD PC

  dba Dearborn Counseling and Resource Center

  • Clinical Psychologist
  • Dearborn, MI
  • NPI 1467664813
  NPD (past)

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1548542186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6585 LUANA AVE",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481012404",
            "telephone_number": "773-991-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30150 TELEGRAPH RD STE 245",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "48025",
            "telephone_number": "800-693-1916",
            "fax_number": "248-605-3525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11470 S Leelanau Hwy Ste 109",
            "address_purpose": "LOCATION",
            "city": "Empire",
            "state": "MI",
            "postal_code": "496309701",
            "country_code": "US",
            "telephone_number": "773-991-3661",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30150 Telegraph Rd Ste 245",
            "address_purpose": "LOCATION",
            "city": "Bingham Farms",
            "state": "MI",
            "postal_code": "48025",
            "country_code": "US",
            "telephone_number": "800-693-1916",
            "fax_number": "248-605-3525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISZAK",
        "first_name": "MARK",
        "middle_name": "GREGORY",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-09",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008523",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jay Alan Inwald, PSY.D.
• Kelly Jennifer Irwin
• Kathleen Marie Isaac
• Ridni Islam
• Hussein Ali Issa, M.D.
• Riyyan Syed Izzathullah
• Ahmed Jaafar
• Heba Jaber
• Dana Jablonski
• Amanda Rice Jackson, M.A.

• Clinical Psychologist in Bingham Farms, MI
• Providers in Bingham Farms, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.