Healthcare Provider Details

I. General information

NPI: 1679569859
Provider Name (Legal Business Name): JOEL SPEAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR #1231
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

777 OAKMONT LN SUITE 1600
WESTMONT IL
60559-5511
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3261
  • Fax: 773-665-9435
Mailing address:
  • Phone: 630-789-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036070345
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: