Provider Demographics
NPI:1417961665
Name:EASTMOND, MARJEAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJEAN
Middle Name:E
Last Name:EASTMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARJEAN
Other - Middle Name:E
Other - Last Name:PAGOTELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:40 SHUMAN BLVD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8446
Mailing Address - Country:US
Mailing Address - Phone:630-868-2200
Mailing Address - Fax:
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:773-665-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109812207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109812Medicaid
ILI37903Medicare UPIN
IL036109812Medicaid