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NPI Code Detail

MEDICARE: JESSICA KANDEL

MEDICARE: JESSICA KANDEL
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
12086S0120XPediatric Surgery Physician036133016IL

General Provider Information

NPI Number : 1912091182
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA KANDEL
Provider Business Mailing Address
First Line : 150 HARVESTER DR
Second Line : SUITE 300
City : BURR RIDGE
State : IL
Zip : 60527-5919
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5841 S MARYLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1443
Country : US
Telephone Number : 888-824-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 10/24/2022

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