MEDICARE: PROMED PREFERRED IL 2 PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	2084P0800X	Psychiatry Physician
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	101YM0800X	Mental Health Counselor
5	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1023855566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED PREFERRED IL 2 PLLC

Provider Business Mailing Address
First Line	:	329 S OYSTER BAY RD # 2059
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-3301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 MARKET PL STE 100
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2089
Country	:	US
Telephone Number	:	615-499-3165
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS JOKERST
Credential	:	DO
Telephone Number	:	615-499-3165

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	06/09/2026

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