Healthcare Provider Details

I. General information

NPI: 1013080241
Provider Name (Legal Business Name): DR. ARDITA TALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARDITA LLESHI-TALI M.D.

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-6435
  • Fax:
Mailing address:
  • Phone: 224-587-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number036.115795
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036 115795
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: