Provider Demographics
NPI:1396725909
Name:APPLEBY, MICHAEL S (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:APPLEBY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W CHICAGO AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3355
Mailing Address - Country:US
Mailing Address - Phone:630-323-0211
Mailing Address - Fax:630-323-0214
Practice Address - Street 1:211 W CHICAGO AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3355
Practice Address - Country:US
Practice Address - Phone:630-323-0211
Practice Address - Fax:630-323-0214
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71004059103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL71004059Medicaid
R18376Medicare UPIN
IL71004059Medicaid