Individual
DR. JEFFREY M MJAANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1611 W HARRISON ST, STE 400, CHICAGO, IL 60612-3841
(312) 243-4244
(312) 942-1517
Mailing address
1 WESTBROOK CORPORATE CTR, #240, WESTCHESTER, IL 60154-5701
(708) 236-2673
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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