Provider Demographics
NPI:1447847355
Name:HAVEN MEDICINE LLC
Entity type:Organization
Organization Name:HAVEN MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-725-2485
Mailing Address - Street 1:2120 W ESTES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3502
Mailing Address - Country:US
Mailing Address - Phone:312-569-0467
Mailing Address - Fax:
Practice Address - Street 1:3255 N ARLINGTON HEIGHTS RD STE 508
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1586
Practice Address - Country:US
Practice Address - Phone:312-725-2485
Practice Address - Fax:773-825-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-26
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty