Individual
DR. JERRY MATTHEW POOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
40 SKOKIE BLVD STE 520, NORTHBROOK, IL 60062-1601
(847) 504-5000
(847) 504-5015
Mailing address
PO BOX 917, NORTHBROOK, IL 60065-0917
(847) 504-5000
(847) 504-5015
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
886-25
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710952999
—
WI
01
—
P01615149
RAILROAD MEDICARE
WI
01
—
P01743256
RAILROAD MEDICARE
IL
Enumeration date
02/21/2006
Last updated
01/22/2019
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