Healthcare Provider Details

I. General information

NPI: 1417063389
Provider Name (Legal Business Name): JEFFREY D. ACKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N. OAK PARK AVENUE
CHICAGO IL
60707-3392
US

IV. Provider business mailing address

PO BOX 8500, LOCKBOX 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-5491
  • Fax:
Mailing address:
  • Phone: 813-281-8115
  • Fax: 813-281-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-066460
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-066460
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: