Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 036-103858 | IL |
N | 208000000X | Pediatrician | 036-103858 | IL |
NPI | 1699870477 |
---|---|
Provider Name | Dr. Edith Jacobson Chernoff |
First Address | Evanston, IL 60203-1809 |
Second Address | Chicago, IL 60649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/12/2020 |