Healthcare Provider Details

I. General information

NPI: 1114489192
Provider Name (Legal Business Name): JUAN PABLO ALBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 16-738
CHICAGO IL
60611-3055
US

IV. Provider business mailing address

251 E HURON ST STE 16-738
CHICAGO IL
60611-3055
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-5924
  • Fax: 312-926-6134
Mailing address:
  • Phone: 312-926-5924
  • Fax: 312-926-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036160195
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036.160195
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.074592
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: