Individual
DR. JONATHAN BENJAMIN IDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
225 E CHICAGO AVE # 25, CHICAGO, IL 60611-2991
(312) 227-6234
(312) 227-9414
Mailing address
225 E CHICAGO AVE # 25, CHICAGO, IL 60611-2991
(312) 227-6234
(312) 227-9414
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
MD.200263
LA
207YP0228X
Pediatric Otolaryngology Physician
Primary
1801070370
IL
207YP0228X
Pediatric Otolaryngology Physician
35.094270
OH
Other
Enumeration date
12/19/2007
Last updated
11/06/2018
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