Organization
JEFFERSON PARK MEDICAL GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD ANSFIELD (DIRECTOR)
(773) 774-7300
Entity
Organization
Contact information
Practice address
5906 N MILWAUKEE AVE, CHICAGO, IL 60646-5420
(773) 774-7300
(773) 774-7313
Mailing address
5906 N MILWAUKEE AVE, CHICAGO, IL 60646-5420
(773) 774-7300
(773) 774-7313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01630200
BLUE CROSS NUMBER
IL
Enumeration date
05/04/2006
Last updated
08/22/2020
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