Healthcare Provider Details

I. General information

NPI: 1710979729
Provider Name (Legal Business Name): HOSEP H DEYRMENJIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 HUNT CLUB RD STE 303
GURNEE IL
60031
US

IV. Provider business mailing address

1445 HUNT CLUB RD STE 303
GURNEE IL
60031-5257
US

V. Phone/Fax

Practice location:
  • Phone: 847-855-3150
  • Fax: 847-855-6006
Mailing address:
  • Phone: 847-855-3150
  • Fax: 847-855-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036079535
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: