Healthcare Provider Details

I. General information

NPI: 1447847355
Provider Name (Legal Business Name): HAVEN MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2020
Last Update Date: 01/03/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 N ARLINGTON HEIGHTS RD STE 508
ARLINGTON HEIGHTS IL
60004-1586
US

IV. Provider business mailing address

2120 W ESTES AVE
CHICAGO IL
60645-3502
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-2485
  • Fax: 773-825-8421
Mailing address:
  • Phone: 312-569-0467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BETH ANN DUNLAP
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 312-725-2485