Healthcare Provider Details

I. General information

NPI: 1598468183
Provider Name (Legal Business Name): MR. JERMAINE ALS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

38405 TAMARAC BLVD APT 110
WILLOUGHBY OH
44094-8179
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-6730
  • Fax:
Mailing address:
  • Phone: 216-926-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901400623
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: