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General NPI Number Information
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NPI Number | 1649384256
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Entity Type | Individual
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Provider Name | AZITA ARDAKANI M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 5201 WILLOW SPRINGS RD STE 120
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City | LA GRANGE HIGHLANDS
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State | IL
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Zip | 60525-6540
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Country | US
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Telephone | 708-245-6097
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 WILLOW SPRINGS RD 120
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City | LA GRANGE HIGHLANDS
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State | IL
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Zip | 60525-6537
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Country | US
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Telephone |
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036-089177
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License Number State | IL
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