Provider Demographics
NPI:1710979729
Name:DEYRMENJIAN, HOSEP H (MD)
Entity Type:Individual
Prefix:
First Name:HOSEP
Middle Name:H
Last Name:DEYRMENJIAN
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 1:1445 HUNT CLUB RD
Mailing Address - Street 2:STE 303
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5257
Mailing Address - Country:US
Mailing Address - Phone:847-855-3150
Mailing Address - Fax:847-855-6006
Practice Address - Street 1:1445 HUNT CLUB RD
Practice Address - Street 2:STE 303
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-855-3150
Practice Address - Fax:847-855-6006
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079535207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079535Medicaid
390240Medicare ID - Type Unspecified
IL036079535Medicaid