Individual
DR. JEANNE MARIE KAIROUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1770 E LAKE SHORE DR STE 105, DECATUR, IL 62521-3800
(217) 422-6100
Mailing address
1770 E LAKE SHORE DR STE 105, DECATUR, IL 62521-3800
(217) 422-6100
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101245153
VA
207RC0000X
Cardiovascular Disease Physician
Primary
036128746
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036128746
—
IL
01
—
1003846908
VA MEDICAID
VA
Enumeration date
07/04/2006
Last updated
12/22/2021
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