Individual
JESSE K PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 TOWER DR, SUITE 105, BURR RIDGE, IL 60527
(630) 325-8681
(630) 325-3936
Mailing address
100 TOWER DR, SUITE 105, BURR RIDGE, IL 60527
(630) 325-8681
(630) 325-3936
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036080235
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D36080235
—
IL
Enumeration date
08/20/2006
Last updated
04/14/2010
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