Healthcare Provider Details

I. General information

NPI: 1780680330
Provider Name (Legal Business Name): JEFFREY EDWARD FIREMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 S ARLINGTON HEIGHTS RD SUITE 210
ARLINGTON HEIGHTS IL
60005-4134
US

IV. Provider business mailing address

2010 S ARLINGTON HEIGHTS RD SUITE 210
ARLINGTON HEIGHTS IL
60005-4134
US

V. Phone/Fax

Practice location:
  • Phone: 847-758-2080
  • Fax: 847-758-2084
Mailing address:
  • Phone: 847-758-2080
  • Fax: 847-758-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-062549
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: