Healthcare Provider Details

I. General information

NPI: 1942959713
Provider Name (Legal Business Name): JOSHUA BURSHTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-8666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number125084300
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: