Individual
JACK C. ENTER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4211 N CICERO AVE, SUITE 100, CHICAGO, IL 60641-1651
(773) 794-1000
(773) 794-9986
Mailing address
10100 FOREST HILLS RD, MACHESNEY PARK, IL 61115-8234
(815) 713-2742
(815) 282-8597
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-000925
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.000925
LICENSE
IL
Enumeration date
08/11/2005
Last updated
10/17/2008
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us