Jesse K. Park Md Sc | |
100 Tower Dr Suite 105 Burr Ridge IL 60527-5777 | |
(630) 325-8681 | |
(630) 325-3936 |
Full Name | Jesse K. Park Md Sc |
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Speciality | Clinic/Center |
Location | 100 Tower Dr, Burr Ridge, Illinois |
Authorized Official Name and Position | Jesse Kitai Park (MEDICAL DOCTOR) |
Authorized Official Contact | 6303258681 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Jesse K. Park Md Sc 100 Tower Dr Suite 105 Burr Ridge IL 60527-5777 Ph: (630) 325-8681 | Jesse K. Park Md Sc 100 Tower Dr Suite 105 Burr Ridge IL 60527-5777 Ph: (630) 325-8681 |
NPI Number | 1942482278 |
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Provider Enumeration Date | 11/28/2007 |
Last Update Date | 02/28/2013 |
Medicare PECOS PAC ID | 5991729667 |
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Medicare Enrollment ID | O20060120000379 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942482278 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 036-080235 (Illinois) | Primary |
Provider Name | Jesse K Park |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1215042072 PECOS PAC ID: 4284658972 Enrollment ID: I20060123000064 |
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