MEDICARE: DR. JEROME ANTOUN JABBOUR MD

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	207Q00000X	Family Medicine Physician	01060708A	IN
2	207Q00000X	Family Medicine Physician	036119492	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255325676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME ANTOUN JABBOUR MD

Provider Business Mailing Address
First Line	:	600 N MCCLURG CT
Second Line	:	3806 A
City	:	CHICAGO
State	:	IL
Zip	:	60611-3044
Country	:	US
Telephone Number	:	248-802-3842
Fax Number	:	248-802-3842

Provider Business Practice Location Address
First Line	:	2310 YORK ST
Second Line	:	SUITE 2 C
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2411
Country	:	US
Telephone Number	:	773-809-3622
Fax Number	:	773-409-8659

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	08/23/2011

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