Organization
JCARE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN P WAITKUS MD (PHYSICIAN)
(773) 238-0627
Entity
Organization
Contact information
Practice address
2701 W 68TH ST, CHICAGO, IL 60629-1813
(773) 884-7983
(773) 884-8065
Mailing address
11860 S BELL AVE, CHICAGO, IL 60643-4720
(773) 238-0627
(773) 884-8065
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632716
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/20/2007
Last updated
08/22/2020
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