Provider Demographics
NPI:1720075740
Name:AVRAMIDIS, JAANA KRISTIINA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAANA
Middle Name:KRISTIINA
Last Name:AVRAMIDIS
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 1:3010 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-377-8546
Mailing Address - Fax:847-377-8808
Practice Address - Street 1:2400 BELVIDERE ROAD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-377-8400
Practice Address - Fax:847-984-5619
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094588174400000X
IL036.094588174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094588Medicaid
IL693413Medicare UPIN