Healthcare Provider Details

I. General information

NPI: 1477477180
Provider Name (Legal Business Name): KAREEM SELMAN-JACKSON MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

707 W SHERIDAN RD APT 229
CHICAGO IL
60613-3235
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125088936
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: