Provider Demographics
NPI:1427150960
Name:VINER, JESSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:L
Last Name:VINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 SHERMAN AVE.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4803
Mailing Address - Country:US
Mailing Address - Phone:847-869-1500
Mailing Address - Fax:847-869-1515
Practice Address - Street 1:1560 SHERMAN AVE.
Practice Address - Street 2:SUITE 400
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4803
Practice Address - Country:US
Practice Address - Phone:847-869-1500
Practice Address - Fax:847-869-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-549582084P0800X
IL036.05495852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry