| Jefferson Park Medical Group, P.c. | |
|
5906 N Milwaukee Ave Chicago IL 60646-5420 | |
| (773) 774-7300 | |
| (773) 774-7313 |
| Full Name | Jefferson Park Medical Group, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 5906 N Milwaukee Ave, Chicago, Illinois |
| Authorized Official Name and Position | Richard Ansfield (DIRECTOR) |
| Authorized Official Contact | 7737747300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Park Medical Group, P.c. 5906 N Milwaukee Ave Chicago IL 60646-5420 Ph: (773) 774-7300 | Jefferson Park Medical Group, P.c. 5906 N Milwaukee Ave Chicago IL 60646-5420 Ph: (773) 774-7300 |
| NPI Number | 1366490047 |
|---|---|
| Provider Enumeration Date | 05/04/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6204731474 |
|---|---|
| Medicare Enrollment ID | O20031201000633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366490047 | NPI | - | NPPES |
| 01630200 | Other | IL | BLUE CROSS NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tonya M Schreder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972664902 PECOS PAC ID: 3476546623 Enrollment ID: I20040405001291 |
| Provider Name | Robert M Kaplan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1073561460 PECOS PAC ID: 3072418250 Enrollment ID: I20040505001242 |
| Provider Name | Thomas Michael Albert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457465098 PECOS PAC ID: 2860453156 Enrollment ID: I20041020000854 |
| Provider Name | Cynthia A Carlson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1477818748 PECOS PAC ID: 6103874946 Enrollment ID: I20050107000527 |
| Provider Name | Riaz A Akhtar |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1407877160 PECOS PAC ID: 8921048612 Enrollment ID: I20050512000362 |
| Provider Name | April C Leddell Hughes |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1619011376 PECOS PAC ID: 2668562547 Enrollment ID: I20071214000727 |
| Provider Name | Olusoji A Peter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225018203 PECOS PAC ID: 2264514561 Enrollment ID: I20080726000013 |
| Provider Name | Olivier Louis Marie Curet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740519198 PECOS PAC ID: 4486813557 Enrollment ID: I20120308000566 |
| Provider Name | Kelley O Holloway Marshall |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1942593231 PECOS PAC ID: 6608026166 Enrollment ID: I20121019000037 |
| Provider Name | Annell S Tucker |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1669784971 PECOS PAC ID: 5991942781 Enrollment ID: I20130515000491 |
| Provider Name | Zachary G Jagmin |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1194012328 PECOS PAC ID: 2264699545 Enrollment ID: I20141024000019 |
| Provider Name | Jamilah F Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154796605 PECOS PAC ID: 7113223769 Enrollment ID: I20160309000240 |
| Provider Name | Marie Fuanya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245697259 PECOS PAC ID: 5092014878 Enrollment ID: I20160428001741 |
| Provider Name | Bianca Cartagena |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861844607 PECOS PAC ID: 4082908769 Enrollment ID: I20160803000267 |
| Provider Name | Kathleen Elizabeth Detwiler |
|---|---|
| Provider Type | Practitioner - Nuclear Medicine |
| Provider Identifiers | NPI Number: 1932465259 PECOS PAC ID: 3274837356 Enrollment ID: I20170328001447 |
| Provider Name | Edith A Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982142527 PECOS PAC ID: 2365702784 Enrollment ID: I20180405001841 |
| Provider Name | Suliyat Idowu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619531753 PECOS PAC ID: 4082957626 Enrollment ID: I20190522000693 |
| Provider Name | Jovan L Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235783267 PECOS PAC ID: 3870926157 Enrollment ID: I20191126002403 |
| Provider Name | Skaiste Tarnauskas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437796133 PECOS PAC ID: 6406280890 Enrollment ID: I20191217002711 |
| Provider Name | Twaniqua Maclin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194387399 PECOS PAC ID: 1254741820 Enrollment ID: I20201110002747 |
| Provider Name | Nekeisha Lynn Sturghill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922633379 PECOS PAC ID: 4981015674 Enrollment ID: I20201202000612 |
| Provider Name | Rosalia Maria Lomeli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891497152 PECOS PAC ID: 3870968522 Enrollment ID: I20230411000801 |
| Provider Name | Alina Calma Nicoara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639865629 PECOS PAC ID: 6305201021 Enrollment ID: I20230503000729 |
| Provider Name | Mohamed Boshnaf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811575145 PECOS PAC ID: 3476961327 Enrollment ID: I20240410000520 |
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