Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 036133462 | IL |
NPI | 1003136458 |
---|---|
Provider Name | Dr. Jason Nathaniel Macklis |
First Address | Chicago, IL 60612-3833 |
Second Address | Park Ridge, IL 60068-1270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 16/12/2021 |