Provider Demographics
NPI:1881101343
Name:GOLZAR, ARTEMIS
Entity type:Individual
Prefix:
First Name:ARTEMIS
Middle Name:
Last Name:GOLZAR
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 1:3001 GREEN BAY RD.
Mailing Address - Street 2:BUILDING II
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:224-610-5841
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD.
Practice Address - Street 2:BUILDING II
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:224-610-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-07-16
Deactivation Date:2024-07-03
Deactivation Code:
Reactivation Date:2024-07-15
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL149.025176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362327294Medicaid