Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-111758 | IL |
N | 111NI0900X | Internist | 036-111758 | IL |
N | 207RG0300X | Geriatric Medicine | 036-111758 | IL |
Y | 207RH0002X | Hospice and Palliative Medicine | 036-111758 | IL |
NPI | 1194764209 |
---|---|
Provider Name | Dr. Jason Maxwell Sobel |
First Address | Glenview, IL 60025-7635 |
Second Address | Glenview, IL 60025-7635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 23/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-111758 | (05) | IL |
11796884 | CAQH (01) | IL |
136039 | (02) | IL |