MEDICARE: DR. JASMEET S DHALIWAL M.D.

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	207W00000X	Ophthalmology Physician	036119696	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962819839	OTHER	IL	NPI NUMBER

General Provider Information

NPI Number	:	1750313771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASMEET S DHALIWAL M.D.

Provider Business Mailing Address
First Line	:	7447 W TALCOTT AVE STE 406
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3715
Country	:	US
Telephone Number	:	773-775-9755
Fax Number	:	773-775-4306

Provider Business Practice Location Address
First Line	:	7447 W TALCOTT AVE
Second Line	:	SUITE 406
City	:	CHICAGO
State	:	IL
Zip	:	60631-3715
Country	:	US
Telephone Number	:	773-775-9755
Fax Number	:	773-775-4306

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	02/20/2024

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