Individual
DR. PAUL R. SANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
30 N MICHIGAN AVE, SUITE 1704, CHICAGO, IL 60602-3402
(312) 332-6091
(312) 332-6508
Mailing address
3647 RADCLIFFE DR, NORTHBROOK, IL 60062-4215
(847) 302-7682
(312) 277-5360
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071002781
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001672882
BLUE CROSS PROVIDER NUMBE
IL
01
—
071002781
PROFESSIONAL LICENSE
IL
01
—
363522880
FEDERAL TAX I.D. NUMBER
IL
Enumeration date
08/01/2006
Last updated
09/09/2020
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