Individual
DR. PHILIP LARKIN JACKSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 E ONTARIO ST, SUITE 200, CHICAGO, IL 60611-3468
(312) 503-7975
(312) 503-5230
Mailing address
211 E ONTARIO ST, SUITE 200, CHICAGO, IL 60611-3468
(312) 503-7975
(312) 503-5230
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01083406A
IN
207P00000X
Emergency Medicine Physician
Primary
036.148100
IL
207P00000X
Emergency Medicine Physician
4301505821
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
03/30/2016
Last updated
07/27/2023
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