| Asj Md Sc | |
|
6508 S Halsted St Chicago IL 60621-2616 | |
| (773) 651-1224 | |
| Not Available |
| Full Name | Asj Md Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 6508 S Halsted St, Chicago, Illinois |
| Authorized Official Name and Position | Anuj Jain (OWNER) |
| Authorized Official Contact | 7736511224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Asj Md Sc 6508 S Halsted St Chicago IL 60621-2616 Ph: (773) 651-1224 | Asj Md Sc 6508 S Halsted St Chicago IL 60621-2616 Ph: (773) 651-1224 |
| NPI Number | 1740776350 |
|---|---|
| Provider Enumeration Date | 07/06/2018 |
| Last Update Date | 10/04/2023 |
| Medicare PECOS PAC ID | 4587914262 |
|---|---|
| Medicare Enrollment ID | O20180829003478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740776350 | NPI | - | NPPES |
| 036131733 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036131733 (Illinois) | Primary |
| Provider Name | Anuj Jain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871893859 PECOS PAC ID: 2567603731 Enrollment ID: I20130731000065 |
| Provider Name | Lashaunda Jones-green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538775846 PECOS PAC ID: 7214383710 Enrollment ID: I20231019000919 |
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