Healthcare Provider Details

I. General information

NPI: 1356667224
Provider Name (Legal Business Name): SARAH ASHLEY ADELSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 970
CHICAGO IL
60612-3828
US

IV. Provider business mailing address

1725 W. HARRISON ST. PROFESSIONAL BUILDING SUITE 970
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-3447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number036-144204
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: