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General NPI Number Information
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NPI Number | 1740776350
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Entity Type | Organization
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Legal Business Name | ASJ MD SC
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 6508 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60621-2616
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Country | US
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Telephone | 773-651-1224
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Fax |
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Provider Business Mailing Address
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Address Line | 6508 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60621-2616
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Country | US
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Telephone | 773-651-1224
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANUJ JAIN
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Credential | MD
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Telephone | 773-651-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036131733
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License Number State | IL
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