Basic Information
Provider Information
NPI: 1881769362
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GEJMAN
FirstName: PABLO
MiddleName: V
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2650 RIDGE AVE
Address2: EVANSTON HOSPITAL
City: EVANSTON
State: IL
PostalCode: 602011718
CountryCode: US
TelephoneNumber: 8475701206
FaxNumber: 8475701248
Practice Location
Address1: 1001 UNIVERSITY PL
Address2:  
City: EVANSTON
State: IL
PostalCode: 602013137
CountryCode: US
TelephoneNumber: 2243647550
FaxNumber: 2243647570
Other Information
ProviderEnumerationDate: 11/21/2006
LastUpdateDate: 01/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X036097886ILY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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