Healthcare Provider Details

I. General information

NPI: 1376819565
Provider Name (Legal Business Name): SAHAR EFTEKHAR D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2012
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E SUPERIOR ST STE 306
CHICAGO IL
60611-2595
US

IV. Provider business mailing address

1 E SUPERIOR ST SUITE 306
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-754-9404
  • Fax: 312-754-9402
Mailing address:
  • Phone: 312-754-9404
  • Fax: 312-754-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number036143296
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036143296
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: