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General NPI Number Information
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NPI Number | 1528133014
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Entity Type | Organization
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Legal Business Name | JB MEDICAL INC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 707 LAKE COOK RD STE 130
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City | DEERFIELD
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State | IL
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Zip | 60015-4938
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Country | US
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Telephone | 847-418-3308
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Fax | 847-418-3309
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Provider Business Mailing Address
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Address Line | 707 LAKE COOK RD STE 130
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City | DEERFIELD
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State | IL
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Zip | 60015-4938
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Country | US
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Telephone | 847-418-3308
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Fax | 847-418-3309
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JULIA MELAMED
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Credential | M.D.
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Telephone | 847-418-3308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036095792
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License Number State | IL
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