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Individual

DENISE L JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
10043 W LINCOLN HWY, FRANKFORT, IL 60423-1272
(708) 709-9300
(708) 709-6353
Mailing address
333 DIXIE HWY, CHICAGO HTS, IL 60411-1748
(708) 756-0100
(708) 709-6353

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036094604
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4673170001
DMERC GROUP
IL
01
P00450388/C K6882
RAILROAD MEDICARE
IL
Enumeration date
05/17/2006
Last updated
10/17/2012
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