Healthcare Provider Details

I. General information

NPI: 1346602968
Provider Name (Legal Business Name): DR. AMIR ADAM TARSHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N LAKEVIEW AVE
CHICAGO IL
60614-1846
US

IV. Provider business mailing address

2500 N LAKEVIEW AVE APT 3401
CHICAGO IL
60614-1829
US

V. Phone/Fax

Practice location:
  • Phone: 312-278-3036
  • Fax: 312-910-1519
Mailing address:
  • Phone: 312-278-3036
  • Fax: 312-910-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125069541
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA173222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: