Individual
JEFFERY P MENDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 N WALL ST, KANKAKEE, IL 60901-2991
(815) 933-1671
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036113476
IL
2085R0204X
Vascular & Interventional Radiology Physician
036-113476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113476
—
IL
01
—
4615054
BCBS ID
IL
Enumeration date
05/17/2007
Last updated
12/04/2023
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