Provider Demographics
NPI:1225134976
Name:ADI PEDIATRIC BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ADI PEDIATRIC BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-577-7705
Mailing Address - Street 1:38785 N DREXEL BLVD
Mailing Address - Street 2:
Mailing Address - City:ANITOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002
Mailing Address - Country:US
Mailing Address - Phone:847-577-7705
Mailing Address - Fax:847-577-7712
Practice Address - Street 1:1100 W CENTRAL
Practice Address - Street 2:#405
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-577-7705
Practice Address - Fax:547-577-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213253Medicare ID - Type Unspecified