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NPI Code Detail

MEDICARE: AVA SADEGHI WIECHERT DO

MEDICARE: AVA SADEGHI WIECHERT DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0200XCritical Care Medicine (Internal Medicine) Physician125.086403IL

General Provider Information

NPI Number : 1588301303
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVA SADEGHI WIECHERT DO
Provider Business Mailing Address
First Line : 1164 W MADISON ST UNIT 420
Second Line :
City : CHICAGO
State : IL
Zip : 60607-3867
Country : US
Telephone Number : 818-437-2157
Fax Number :
Provider Business Practice Location Address
First Line : 20201 CRAWFORD AVE
Second Line :
City : OLYMPIA FIELDS
State : IL
Zip : 60461-1010
Country : US
Telephone Number : 708-747-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2022
Last Update Date : 03/12/2026

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