Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 036121874 | IL |
N | 207SG0201X | Clinical Genetics (M.D.) | 66311-20 | WI |
NPI | 1710141551 |
---|---|
Provider Name | Dr. Jillene Michelle Kogan |
First Address | Rosemont, IL 60018-5305 |
Second Address | Rosemont, IL 60018-5305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 09/12/2021 |