Healthcare Provider Details

I. General information

NPI: 1417956509
Provider Name (Legal Business Name): PAUL JOHN JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST SUITE 550
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

2160 S 1ST AVE SUITE 550
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6100
  • Fax: 312-942-6225
Mailing address:
  • Phone: 708-216-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036069104
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number036069104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: