Individual
JAWED EHSAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 LARKIN AVE, ELGIN, IL 60123-5272
(847) 742-0165
(847) 742-0190
Mailing address
P O BOX 3412, OAK BROOK, IL 60522-3412
(773) 343-9844
(847) 741-6588
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
IL
207R00000X
Internal Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04532181
BLUE CROSS BLUE SHIELD
IL
01
—
04532390
BCBS
IL
01
—
209598
MEDICARE ID
—
01
—
P00090413
RAILROAD
—
Enumeration date
11/30/2005
Last updated
02/22/2008
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