Healthcare Provider Details

I. General information

NPI: 1265182893
Provider Name (Legal Business Name): JESSICA SARGON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC4065
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5841 S MARYLAND AVE # MC4065
CHICAGO IL
60637-1443
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6418
  • Fax: 773-702-0666
Mailing address:
  • Phone: 773-702-6418
  • Fax: 773-702-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036173904
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: