| 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 | Robert M Kaplan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1073561460 PECOS PAC ID: 3072418250 Enrollment ID: I20040505001242 |
| 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 | Rosalia Maria Lomeli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891497152 PECOS PAC ID: 3870968522 Enrollment ID: I20230411000801 |
| Provider Name | Mohamed Boshnaf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811575145 PECOS PAC ID: 3476961327 Enrollment ID: I20240410000520 |
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