Individual
DR. JACK M PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, APRNFPA, FNP-BC
Contact information
Practice address
4947 N WINTHROP AVE, CHICAGO, IL 60640-3607
(773) 455-4325
(773) 838-0902
Mailing address
4947 N WINTHROP AVE, MEDICAL CENTER FLR 1, CHICAGO, IL 60640-3607
(773) 455-4325
(773) 838-0902
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209027448
IL
363LF0000X
Family Nurse Practitioner
Primary
209027448
IL
363LP2300X
Primary Care Nurse Practitioner
209027448
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041460482
IDFPR NURSING BOARD
IL
01
—
2023019429
ANCC
—
Enumeration date
01/11/2018
Last updated
05/17/2026
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