Individual
JEE MIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2650 RIDGE AVE STE 1304, EVANSTON, IL 60201-1700
(847) 570-2700
Mailing address
2650 RIDGE AVE STE 1223, EVANSTON, IL 60201-1700
(847) 982-6715
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036164784
IL
208M00000X
Hospitalist Physician
Primary
036164784
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/27/2020
Last updated
06/30/2023
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