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Individual

DR. MICHAEL PATRICK KAHWAJI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
2502 B EAST EMPIRE, BLOOMINGTON, IL 61704
(309) 663-7220
(309) 664-6687
Mailing address
PO BOX 604, BLOOMINGTON, IL 61702-0604
(309) 663-7220
(309) 664-6687

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
044404
HEALTH ALLIANCE
IL
Enumeration date
06/22/2006
Last updated
07/08/2007
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