Individual
DR. JONATHAN SAMET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
225 E CHICAGO AVE, DEPT. OF MEDICAL IMAGING, CHICAGO, IL 60611
(312) 227-3502
Mailing address
225 E CHICAGO AVE, BOX 09, DEPT. OF MEDICAL IMAGING, CHICAGO, IL 60611-2605
(312) 227-3502
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
036-124632
IL
2085R0202X
Diagnostic Radiology Physician
125052416
IL
2085R0202X
Diagnostic Radiology Physician
Primary
36-124632
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056010300
—
MD
01
—
125052416
TEMPORARY ILLINOIS PHYSICIAN LICENSE
IL
Enumeration date
08/05/2008
Last updated
06/17/2022
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