Healthcare Provider Details

I. General information

NPI: 1497980452
Provider Name (Legal Business Name): JILMA PATRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 S WABASH AVE STE 4
CHICAGO IL
60616-2051
US

IV. Provider business mailing address

1935 S WABASH AVE STE 4
CHICAGO IL
60616-2051
US

V. Phone/Fax

Practice location:
  • Phone: 312-775-2313
  • Fax: 312-586-8124
Mailing address:
  • Phone: 312-775-2313
  • Fax: 312-472-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.135714
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: