Provider Demographics
NPI:1235432634
Name:SINGH, JAGADEESH SOM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGADEESH
Middle Name:SOM
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAGADEESH
Other - Middle Name:SINGH
Other - Last Name:SOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1926 W HARRISON ST
Mailing Address - Street 2:SUITE NO 809
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3737
Mailing Address - Country:US
Mailing Address - Phone:312-602-3306
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-5495
Practice Address - Fax:312-942-5727
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250586732085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology