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General NPI Number Information
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NPI Number | 1710141551
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Entity Type | Individual
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Provider Name | JILLENE MICHELLE KOGAN M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 5400 PEARL ST
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City | ROSEMONT
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State | IL
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Zip | 60018-5305
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Country | US
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Telephone | 847-349-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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Fax |
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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 | 207SC0300X
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Taxonomy Name | Clinical Cytogenetics Physician
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License Number | 66311-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207SC0300X
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Taxonomy Name | Clinical Cytogenetics Physician
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License Number | 036121874
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 66311-20
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 036121874
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License Number State | IL
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