Healthcare Provider Details

I. General information

NPI: 1316146392
Provider Name (Legal Business Name): SARA ELIZABETH JANDESKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

124 FRANK LLOYD WRIGHT LN
OAK PARK IL
60302-2643
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-5023
  • Fax:
Mailing address:
  • Phone: 702-358-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-111733
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number3611473
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: