Healthcare Provider Details

I. General information

NPI: 1417341785
Provider Name (Legal Business Name): ANDREW GARTNER BIRKHEAD MD FAAFP FASAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W 69TH ST
CHICAGO IL
60621-1147
US

IV. Provider business mailing address

1135 W 69TH ST
CHICAGO IL
60621-1147
US

V. Phone/Fax

Practice location:
  • Phone: 773-483-5011
  • Fax: 773-483-5259
Mailing address:
  • Phone: 773-483-5011
  • Fax: 773-483-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number036.144124
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.144124
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: