Provider Demographics
NPI:1669582417
Name:JABR, AYMAN M (MD)
Entity type:Individual
Prefix:
First Name:AYMAN
Middle Name:M
Last Name:JABR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W DIVISION
Mailing Address - Street 2:ST MARY AND ELIZABETH MEDICAL CENTER SUITE 2100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:773-227-3770
Mailing Address - Fax:773-486-5224
Practice Address - Street 1:2222 W DIVISION
Practice Address - Street 2:ST MARY AND ELIZABETH MEDICAL CENTER SUITE 2100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-227-3770
Practice Address - Fax:773-486-5224
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036110045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
K15272Medicare ID - Type Unspecified
H99911Medicare UPIN