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General NPI Number Information
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NPI Number | 1417341785
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Entity Type | Individual
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Provider Name | ANDREW GARTNER BIRKHEAD MD FAAFP FASAM
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Gender | Male
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 1135 W 69TH ST
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City | CHICAGO
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State | IL
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Zip | 60621-1147
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Country | US
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Telephone | 773-483-5011
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Fax | 773-483-5259
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Provider Business Mailing Address
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Address Line | 1135 W 69TH ST
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City | CHICAGO
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State | IL
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Zip | 60621-1147
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Country | US
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Telephone | 773-483-5011
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Fax | 773-483-5259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 036.144124
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.144124
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License Number State | IL
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