Individual
DR. JAN LEI IWATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1 E SUPERIOR ST, 307, CHICAGO, IL 60611-2507
(773) 501-7394
(773) 296-7787
Mailing address
4600 N CLARENDON AVE, 1202, CHICAGO, IL 60640-5710
(773) 501-7394
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
036-105234
IL
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
7541
CA
207W00000X
Ophthalmology Physician
036-105234
IL
207W00000X
Ophthalmology Physician
7541
CA
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
036-105234
IL
2083P0901X
Public Health & General Preventive Medicine Physician
7541
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632904
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/07/2006
Last updated
01/08/2014
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