Healthcare Provider Details

I. General information

NPI: 1720009228
Provider Name (Legal Business Name): JINCY K JOSEPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 RANDALL RD
CARPENTERSVILLE IL
60110-3355
US

IV. Provider business mailing address

1942 DEMPSTER ST
EVANSTON IL
60202-1016
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-3200
  • Fax:
Mailing address:
  • Phone: 847-688-1900
  • Fax: 224-610-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036116215
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: