Healthcare Provider Details

I. General information

NPI: 1205256492
Provider Name (Legal Business Name): JAMIE TITEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

PO BOX 24569
BELFAST ME
04915-4496
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2509
  • Fax:
Mailing address:
  • Phone: 800-329-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11332948-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCDRH.1942
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036142520
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: