Healthcare Provider Details

I. General information

NPI: 1215422084
Provider Name (Legal Business Name): EVIN ARYAN KOLEINI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W TALCOTT AVE
CHICAGO IL
60631-3707
US

IV. Provider business mailing address

830 N ASHLAND AVE
CHICAGO IL
60622-5684
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5177
  • Fax:
Mailing address:
  • Phone: 773-280-7001
  • Fax: 773-280-7597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036159914
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036159914
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: