Healthcare Provider Details

I. General information

NPI: 1487874988
Provider Name (Legal Business Name): DANGREMOND & JAHARIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 GREEN BAY RD
WINNETKA IL
60093
US

IV. Provider business mailing address

750 GREEN BAY RD
WINNETKA IL
60093
US

V. Phone/Fax

Practice location:
  • Phone: 847-446-0202
  • Fax: 847-446-0208
Mailing address:
  • Phone: 847-446-0202
  • Fax: 847-446-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036078117
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036073154
License Number StateIL

VIII. Authorized Official

Name: MRS. IRINA V BORISOVA
Title or Position: BILLING MNGR
Credential:
Phone: 847-446-0202