Healthcare Provider Details

I. General information

NPI: 1164335840
Provider Name (Legal Business Name): AJ MEDICAL 1, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N LARKIN AVE UPPR LEVEL
JOLIET IL
60435-3455
US

IV. Provider business mailing address

447 CREEKSIDE CT
WILLOWBROOK IL
60527-5492
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-6226
  • Fax: 815-725-6336
Mailing address:
  • Phone: 248-210-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANAS JABER
Title or Position: PRESIDENT
Credential: MD
Phone: 248-210-4064