Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | Q6769 | TX |
N | 111NI0900X | Internist | Q6769 | TX |
Y | 207RN0300X | Nephrologist | 036.151545 | IL |
NPI | 1023375300 |
---|---|
Provider Name | Jon William Mares |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Chicago, IL 60637-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 28/04/2020 |