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Individual
DR. JEFFREY M MJAANES
Active
Individual
DR. JEFFREY M MJAANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2080S0010X
Pediatric Sports Medicine Physician
Primary
036107254
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107254 2
—
IL
01
—
1633878
BCBS PROVIDER NUMBER
IL
01
—
207067
MEDICARE PTAN NUMBER LOCALITY #16
IL
01
—
207073
MEDICARE PTAN NUMBER LOCALITY #15
IL
01
—
7081518
AETNA PROVIDER NUMBER
—
Enumeration date
06/28/2006
Last updated
09/18/2012
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