MEDICARE: DR. JAIRO ALBERTO MEJIA M.D.

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	207R00000X	Internal Medicine Physician	36-112606	IL

General Provider Information

NPI Number	:	1952361164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIRO ALBERTO MEJIA M.D.

Provider Business Mailing Address
First Line	:	2533 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3719
Country	:	US
Telephone Number	:	773-523-0900
Fax Number	:	773-523-9168

Provider Business Practice Location Address
First Line	:	2533 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3719
Country	:	US
Telephone Number	:	773-523-0900
Fax Number	:	773-523-9168

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	05/13/2012

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