Healthcare Provider Details

I. General information

NPI: 1013096866
Provider Name (Legal Business Name): AMIR K SEPAHDARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVENUE SWEDISH COVENANT HOSPITAL
CHICAGO IL
60625
US

IV. Provider business mailing address

1895 ADMIRAL CT
GLENVIEW IL
60026-8055
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3814
  • Fax: 773-989-6230
Mailing address:
  • Phone: 847-724-2708
  • Fax: 773-989-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036105387
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: