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General NPI Number Information
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NPI Number | 1669068797
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Entity Type | Organization
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Legal Business Name | MODERN MENTAL HEALTH BY DR. ZACHARY KORDIK, PLLC
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Dates
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Enumeration Date | 12/13/2020
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST STE 1601
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City | CHICAGO
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State | IL
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Zip | 60602-1882
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Country | US
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Telephone | 312-566-7936
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Fax | 312-276-4000
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST STE 1601
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City | CHICAGO
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State | IL
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Zip | 60602-1882
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Country | US
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Telephone | 312-566-7936
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Fax | 312-276-4000
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZACHARY ANDREW KORDIK
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Credential | MD
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Telephone | 312-566-7936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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