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General NPI Number Information
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NPI Number | 1124233291
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Entity Type | Individual
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Provider Name | JOUMANA TANNOUS CHAIBAN MD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 11600 S KEDZIE AVE STE D
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City | MERRIONETTE PARK
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State | IL
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Zip | 60803-6308
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Country | US
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Telephone | 708-684-6867
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Fax | 708-684-6869
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE C B 8127
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone | 314-747-3000
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Fax | 314-747-7065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 2015013437
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 036-133347
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License Number State | IL
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