MEDICARE: JONATHAN SETH ADELSTEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician	036144161	IL
2	2084P0800X	Psychiatry Physician	036144161	IL

General Provider Information

NPI Number	:	1053603613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN SETH ADELSTEIN M.D.

Provider Business Mailing Address
First Line	:	4610 N CLARK ST # 1028
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4620
Country	:	US
Telephone Number	:	773-747-5500
Fax Number	:	773-747-5586

Provider Business Practice Location Address
First Line	:	4610 N CLARK ST # 1028
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4620
Country	:	US
Telephone Number	:	773-747-5500
Fax Number	:	773-747-5586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2011
Last Update Date	:	06/08/2021

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