Individual
DR. JAY BOUGHANEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
676 N SAINT CLAIR ST FL 13, DEPARTMENT OF ORTHOPAEDIC SURGERY, CHICAGO, IL 60611-3060
(312) 926-4485
Mailing address
2718 N WILTON AVE, UNIT 2, CHICAGO, IL 60614-2875
(312) 371-1861
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036120773
IL
207X00000X
Orthopaedic Surgery Physician
73259-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518115948
—
WI
Enumeration date
08/27/2008
Last updated
07/11/2023
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