Provider Demographics
NPI:1144239369
Name:AJMERE, KISHOR G (MD)
Entity type:Individual
Prefix:MR
First Name:KISHOR
Middle Name:G
Last Name:AJMERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2435 GLENWOOD AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5461
Mailing Address - Country:US
Mailing Address - Phone:815-744-6005
Mailing Address - Fax:815-744-6023
Practice Address - Street 1:2435 GLENWOOD AVE
Practice Address - Street 2:STE 110
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5461
Practice Address - Country:US
Practice Address - Phone:815-744-6005
Practice Address - Fax:815-744-6023
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9900432OtherBC/BS OF ILLINOIS
IL9900432OtherBC/BS OF ILLINOIS
IL247770Medicare ID - Type Unspecified