Healthcare Provider Details

I. General information

NPI: 1063614964
Provider Name (Legal Business Name): MONIKA KARYN JAFFE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N CENTRAL AVE
CHICAGO IL
60634-4426
US

IV. Provider business mailing address

1730 HEATHER LN
HIGHLAND PARK IL
60035-3718
US

V. Phone/Fax

Practice location:
  • Phone: 847-902-5540
  • Fax:
Mailing address:
  • Phone: 847-902-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036125212
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: