Organization
JERRY J ITKONEN, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM WYLIE (OFFICE MANAGER)
(708) 799-8440
Entity
Organization
Contact information
Practice address
71 W 156TH ST, SUITE 203, HARVEY, IL 60426-4260
(708) 331-0405
Mailing address
18141 DIXIE HWY, SUITE 107, HOMEWOOD, IL 60430-2238
(708) 799-8440
(708) 799-8446
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036060989
IL
Other
Enumeration date
04/16/2007
Last updated
08/15/2008
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