# DR. JEFFREY M MJAANES

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1083641427
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080S0010X | Pediatric Sports Medicine Physician | 036107254 | IL | Yes |

## Other

- **Enumeration date:** 06/28/2006
- **Last updated:** 09/18/2012

## 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 | — |