Provider Demographics
NPI:1881677730
Name:TAKHSH, EDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:
Last Name:TAKHSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1410
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-726-7272
Mailing Address - Fax:312-899-8382
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-726-7272
Practice Address - Fax:312-899-8382
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096668207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096668Medicaid
IL036096668Medicaid
ILH06475Medicare UPIN