Individual provider Active NPI

Angielyn Maureen Sanjuan, DO

  • Pediatric Orthopaedic Surgery Physician
  • Skokie, IL
National Provider Identifier
1114338126
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X
License
036157260 Issued in IL
Practice address
9650 Gross Point Rd Ste 2900
Skokie, IL 60076-5006
Phone
(847) 866-7846
Fax
(224) 251-4568
NPI assigned
May 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Orthopaedic Surgery Physician 207XP3100X 036157260 IL Primary

Addresses

Primary practice location

9650 Gross Point Rd Ste 2900
Skokie, IL 60076-5006

Mailing address

9650 Gross Point Rd Ste 2900
Skokie, IL 60076-5006
Phone (847) 866-7846

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210826003207 IL Practitioner - Orthopedic Surgery 2163717547 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036157260ILMDPediatric Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Orthopaedic Surgery CurrentSince Aug 17, 2021 Accepting new patients
Endeavor Health Medical Group CurrentSince Aug 17, 2021 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

9650 Gross Point Rd
Ste 2900
Skokie, IL 60076

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1114338126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9650 GROSS POINT RD STE 2900",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600765006",
            "telephone_number": "847-866-7846",
            "fax_number": "224-251-4568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9650 GROSS POINT RD STE 2900",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600765006",
            "telephone_number": "847-866-7846",
            "fax_number": "224-251-4568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANJUAN",
        "first_name": "ANGIELYN",
        "middle_name": "MAUREEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-13",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "IL",
            "license": "036157260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.