Provider Demographics
NPI:1538105861
Name:JAHARIS, STEVEN M (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:JAHARIS
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 1:750 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1938
Mailing Address - Country:US
Mailing Address - Phone:847-446-0202
Mailing Address - Fax:847-446-0208
Practice Address - Street 1:750 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1938
Practice Address - Country:US
Practice Address - Phone:847-446-0202
Practice Address - Fax:847-446-0208
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E60965Medicare UPIN
ILL90280Medicare ID - Type Unspecified