Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | IL |
NPI | 1083649990 |
---|---|
Provider Name | Mairaj Jaleel |
First Address | Chicago, IL 60674-2368 |
Second Address | Berwyn, IL 60402-3429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I57185 | (02) |