Provider Demographics
NPI:1700250651
Name:SALEKI-HADAVAND, ARMITA
Entity Type:Individual
Prefix:
First Name:ARMITA
Middle Name:
Last Name:SALEKI-HADAVAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE GRN STE 120B
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3094
Mailing Address - Country:US
Mailing Address - Phone:847-279-0061
Mailing Address - Fax:
Practice Address - Street 1:1800 HOLLISTER DR STE 112
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5265
Practice Address - Country:US
Practice Address - Phone:847-367-6781
Practice Address - Fax:847-367-8008
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013542364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology