Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036150906 | IL |
NPI | 1265879209 |
---|---|
Provider Name | Miss Aswathi Jayaram |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2013 |
Last Update Date | 07/07/2020 |