Provider Demographics
NPI:1487874988
Name:DANGREMOND & JAHARIS LLC
Entity type:Organization
Organization Name:DANGREMOND & JAHARIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MNGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BORISOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-446-0202
Mailing Address - Street 1:750 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:847-446-0202
Mailing Address - Fax:847-446-0208
Practice Address - Street 1:750 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-446-0202
Practice Address - Fax:847-446-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078117207Q00000X
IL036073154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200840Medicare ID - Type Unspecified