Healthcare Provider Details

I. General information

NPI: 1982940631
Provider Name (Legal Business Name): JENNIFER EDEN POGORILER MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S. MARYLAND AVE, MC 6101, ROOM P615A UNIVERSITY OF CHICAGO DEPARTMENT OF PATHOLOGY
CHICAGO IL
60637
US

IV. Provider business mailing address

5841 S. MARYLAND AVE, MC 6101, ROOM P615A, UNIVERSITY OF CHICAGO DEPARTMENT OF PATHOLOGY
CHICAGO IL
60637
US

V. Phone/Fax

Practice location:
  • Phone: 773-834-8382
  • Fax:
Mailing address:
  • Phone: 773-834-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036.129498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: