MEDICARE: DR. JOSHUA BENJAMIN EWEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0005X	Neurodevelopmental Disabilities Physician	036167430	IL
2	208000000X	Pediatrics Physician	036167430	IL
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	036167430	IL
4	2084N0600X	Clinical Neurophysiology Physician	036167430	IL

General Provider Information

NPI Number	:	1518013671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA BENJAMIN EWEN M.D.

Provider Business Mailing Address
First Line	:	225 E CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2991
Country	:	US
Telephone Number	:	312-227-6839
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 E CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2991
Country	:	US
Telephone Number	:	312-227-6839
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	01/06/2026

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