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Individual

DR. JASON BOHM WALDINGER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
71 WAUKEGAN RD STE 700, LAKE BLUFF, IL 60044-1614
(847) 433-2620
Mailing address
2650 RIDGE AVE STE 1223, EVANSTON, IL 60201-1700
(847) 570-2040
(847) 433-8727

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036.134256
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
125058305
STATE OF ILLINOIS MEDICAL LICENSE NUMBER
IL
Enumeration date
07/12/2010
Last updated
03/03/2021
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