Healthcare Provider Details

I. General information

NPI: 1063488294
Provider Name (Legal Business Name): JACQUES FOURCAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 W 64TH ST SUITE 208
CHICAGO IL
60621-3114
US

IV. Provider business mailing address

PO BOX 5979
BUFFALO GROVE IL
60089-5979
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-3900
  • Fax:
Mailing address:
  • Phone: 847-897-5995
  • Fax: 847-897-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: