Mjaanes, Jeffrey M

Mjaanes, Jeffrey M is an individual health care provider with primary practice located at 1611 W Harrison St Ste 400, Chicago IL 60612-3841. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Mjaanes, Jeffrey M can be contacted via phone (312) 243-4244.

Contact Information

Primary practice address
1611 W Harrison St Ste 400 Chicago IL 60612-3841
Phone: (312) 243-4244
Fax: (312) 942-1517
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 2080S0010X 036107254 Illinois

Profile Details

NPI number 1083641427
LBN Legal business name Mjaanes, Jeffrey M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2006
Last updated Sep 18th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083641427 NPPES
Illinois MEDICAID 036107254 2
Illinois Other 1633878
Illinois Other 7081518
Illinois Other 207073
Illinois Other 207067

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