Healthcare Provider Details

I. General information

NPI: 1720033160
Provider Name (Legal Business Name): JONATHAN H MAKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 LAKE AVE STE A
WILMETTE IL
60091-1480
US

IV. Provider business mailing address

1921 LAKE AVE STE A
WILMETTE IL
60091-1480
US

V. Phone/Fax

Practice location:
  • Phone: 847-464-9050
  • Fax:
Mailing address:
  • Phone: 847-464-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-103034
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036-103034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: