MEDICARE: AYMAN M JABR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036110045	IL

General Provider Information

NPI Number	:	1669582417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYMAN M JABR MD

Provider Business Mailing Address
First Line	:	2222 W DIVISION
Second Line	:	ST MARY AND ELIZABETH MEDICAL CENTER SUITE 2100
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	773-227-3770
Fax Number	:	773-486-5224

Provider Business Practice Location Address
First Line	:	2222 W DIVISION
Second Line	:	ST MARY AND ELIZABETH MEDICAL CENTER SUITE 2100
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	773-227-3770
Fax Number	:	773-486-5224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/26/2011

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