Provider Demographics
NPI:1720009228
Name:JOSEPH, JINCY K (MD)
Entity Type:Individual
Prefix:DR
First Name:JINCY
Middle Name:K
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1016
Mailing Address - Country:US
Mailing Address - Phone:847-688-1900
Mailing Address - Fax:224-610-8595
Practice Address - Street 1:2201 RANDALL RD
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-3355
Practice Address - Country:US
Practice Address - Phone:847-695-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116215Medicaid
IL2232882OtherBCBS
IL2232882OtherBCBS
ILK34126Medicare PIN