MEDICARE: JAKUB PODOSEK PMHNP-BC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209033636	IL

General Provider Information

NPI Number	:	1215468566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKUB PODOSEK PMHNP-BC

Provider Business Mailing Address
First Line	:	836 S ARLINGTON HEIGHTS RD STE 342
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3667
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	11/20/2025

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