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NPI Code Detail

MEDICARE: JUSTIN LIST MD

MEDICARE: JUSTIN LIST 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
1207R00000XInternal Medicine Physician036158455IL
2207R00000XInternal Medicine Physician281804NY

General Provider Information

NPI Number : 1871818195
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN LIST MD
Provider Business Mailing Address
First Line : 3501 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-1832
Country : US
Telephone Number : 773-388-1600
Fax Number :
Provider Business Practice Location Address
First Line : 3501 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-1832
Country : US
Telephone Number : 773-388-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2010
Last Update Date : 06/02/2026

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Directions to “ JUSTIN LIST MD” Practice Location

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