Provider Demographics
NPI:1518126184
Name:BAQAI, JEANINE ALYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:ALYCE
Last Name:BAQAI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:NORTHWESTERN MEDICAL FACULTY FOUNDATION SUITE 1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3092
Mailing Address - Country:US
Mailing Address - Phone:312-695-0665
Mailing Address - Fax:312-695-0665
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:NORTHWESTERN MEDICAL FACULTY FOUNDATION SUITE 1000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3092
Practice Address - Country:US
Practice Address - Phone:312-695-0665
Practice Address - Fax:312-695-0665
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2015-07-22
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Provider Licenses
StateLicense IDTaxonomies
IL036130994207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL340850002Medicare PIN