Provider Demographics
NPI:1710141551
Name:KOGAN, JILLENE MICHELLE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JILLENE
Middle Name:MICHELLE
Last Name:KOGAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5305
Mailing Address - Country:US
Mailing Address - Phone:847-349-7300
Mailing Address - Fax:
Practice Address - Street 1:5400 PEARL ST
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-5305
Practice Address - Country:US
Practice Address - Phone:847-349-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66311-20207SC0300X, 207SG0201X
IL036121874207SC0300X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics