Provider Demographics
NPI:1053603613
Name:ADELSTEIN, JONATHAN SETH (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SETH
Last Name:ADELSTEIN
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 1:4610 N CLARK ST # 1028
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4620
Mailing Address - Country:US
Mailing Address - Phone:773-747-5500
Mailing Address - Fax:773-747-5586
Practice Address - Street 1:4610 N CLARK ST # 1028
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4620
Practice Address - Country:US
Practice Address - Phone:773-747-5500
Practice Address - Fax:773-747-5586
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361441612084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry