Provider Demographics
NPI:1225122393
Name:ENGEL, JUAN JACOBO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JACOBO
Last Name:ENGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3159
Mailing Address - Country:US
Mailing Address - Phone:847-318-9595
Mailing Address - Fax:847-318-9599
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-318-9595
Practice Address - Fax:847-318-9599
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13036Medicare UPIN
ILL71780Medicare PIN