Individual
JONATHAN WILLIAM JANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4700
(630) 933-4427
Mailing address
12251 S. 80TH AVENUE, MED STAFF OFFICE SUITE 1630, PALOS HEIGHTS, IL 60463
(708) 923-5173
(708) 923-5018
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036136259
IL
208M00000X
Hospitalist Physician
Primary
036136259
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036136259
—
IL
01
—
206147
MEDICARE GROUP
IL
01
—
F400262423
MEDICARE PTAN
IL
Enumeration date
04/06/2009
Last updated
05/24/2023
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