Healthcare Provider Details

I. General information

NPI: 1386637874
Provider Name (Legal Business Name): DEEPAK JAJOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S CALIFORNIA AVE
CHICAGO IL
60608-1732
US

IV. Provider business mailing address

3537 PAYSPHERE CIR
CHICAGO IL
60674-0035
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6472
  • Fax:
Mailing address:
  • Phone: 708-786-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number036-105263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: