Healthcare Provider Details

I. General information

NPI: 1003916586
Provider Name (Legal Business Name): SAMARJIT S JAGLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 GOLF RD SUITE 300
DES PLAINES IL
60016-6850
US

IV. Provider business mailing address

4224 COMMERCIAL WAY
GLENVIEW IL
60025-3573
US

V. Phone/Fax

Practice location:
  • Phone: 847-824-3198
  • Fax: 847-824-1291
Mailing address:
  • Phone: 847-298-7024
  • Fax: 847-298-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036069867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: