Provider Demographics
NPI:1417489238
Name:JOSE, JOGIN (MD)
Entity Type:Individual
Prefix:
First Name:JOGIN
Middle Name:
Last Name:JOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3906
Mailing Address - Country:US
Mailing Address - Phone:847-392-9220
Mailing Address - Fax:847-392-9252
Practice Address - Street 1:1588 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3906
Practice Address - Country:US
Practice Address - Phone:847-392-9220
Practice Address - Fax:847-392-9252
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-157176207W00000X
IL125070460207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362765923OtherOPHTHALMOLOGY