Healthcare Provider Details

I. General information

NPI: 1770683351
Provider Name (Legal Business Name): AMIN N DAGHESTANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18W100 22ND ST SUITE 130
OAKBROOK TERRACE IL
60181-4499
US

IV. Provider business mailing address

PO BOX 387
ADDISON IL
60101-0387
US

V. Phone/Fax

Practice location:
  • Phone: 630-424-9204
  • Fax:
Mailing address:
  • Phone: 630-424-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: