# JEFFERSON PARK MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194934208
- **Authorized official:** PIERRE CHATELAIN (OPERATIONS MANAGER)
- **Authorized official phone:** (630) 209-8405

## Contact information

- **Practice address:** 4955 N MILWAUKEE AVE, CHICAGO, IL 60630-2286
- **Practice address phone:** (630) 209-8405
- **Practice address fax:** (773) 736-1403
- **Mailing address:** 4955 N MILWAUKEE AVE, CHICAGO, IL 60630-2286
- **Mailing address phone:** (630) 209-8405
- **Mailing address fax:** (773) 736-1403

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 07/10/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036046595 | — | IL |