Healthcare Provider Details

I. General information

NPI: 1952833329
Provider Name (Legal Business Name): JASON DEVIN ROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 5-704
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST STE 5-704
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0061
  • Fax: 312-695-9013
Mailing address:
  • Phone: 312-695-0061
  • Fax: 312-695-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number287417
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036160827
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: