Provider Demographics
NPI:1780761692
Name:KORAH, VEENA JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:VEENA
Middle Name:JACOB
Last Name:KORAH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-6715
Mailing Address - Fax:847-982-3394
Practice Address - Street 1:320 N MORGAN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1321
Practice Address - Country:US
Practice Address - Phone:889-269-3858
Practice Address - Fax:312-229-8817
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036113959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113959Medicaid