Healthcare Provider Details

I. General information

NPI: 1275929440
Provider Name (Legal Business Name): SARA KASHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DAVIS ST
EVANSTON IL
60201-4668
US

IV. Provider business mailing address

500 DAVIS ST STE 815
EVANSTON IL
60201-4655
US

V. Phone/Fax

Practice location:
  • Phone: 312-640-7740
  • Fax:
Mailing address:
  • Phone: 312-477-2122
  • Fax: 847-563-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1013134
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: