Organization
JASAM MEDICAL SC
Active
Parent organization
JASAM MEDICAL SC
Organization subpart
Yes
Provider details
NPI number
Legal business name
JASAM MEDICAL SC
Authorized official
CHIMANBHAI PATEL (PRESIDENT)
(773) 292-9660
Entity
Organization
Contact information
Practice address
2749 W NORTH AVE, CHICAGO, IL 60647-5246
(773) 292-9660
Mailing address
PO BOX 607, SKOKIE, IL 60076-0607
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211682
MEDICARE GRP #
IL
Enumeration date
12/02/2006
Last updated
12/21/2007
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