Healthcare Provider Details

I. General information

NPI: 1154508570
Provider Name (Legal Business Name): JAMIL B DIHU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

1769 CAMPBELL AVE
DES PLAINES IL
60016-6771
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036124341
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036124341
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: