Healthcare Provider Details

I. General information

NPI: 1568124568
Provider Name (Legal Business Name): HARDIK KOTAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 N MARSHFIELD AVE UNIT 3
CHICAGO IL
60626-7227
US

IV. Provider business mailing address

7700 N MARSHFIELD AVE UNIT 3
CHICAGO IL
60626-7227
US

V. Phone/Fax

Practice location:
  • Phone: 773-234-6523
  • Fax:
Mailing address:
  • Phone: 773-827-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: