Individual
JORGE E FERNALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7300 W COLLEGE DR, SUITE #101, PALOS HEIGHTS, IL 60463
(708) 448-8470
Mailing address
7300 W COLLEGE DR, SUITE #101, PALOS HEIGHTS, IL 60463-1152
(708) 448-8470
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036-085526
IL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036-095526
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036095526
—
IL
01
—
F400488988
MEDICARE
IL
Enumeration date
01/09/2007
Last updated
08/23/2018
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