Healthcare Provider Details

I. General information

NPI: 1629950001
Provider Name (Legal Business Name): JAN JAKUB DRELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N. OAKLEY BLVD. 2ND FLOOR
CHICAGO IL
60622
US

IV. Provider business mailing address

1127 N. OAKLEY BLVD. 2ND FLOOR
CHICAGO IL
60622
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2040
  • Fax: 312-770-3270
Mailing address:
  • Phone: 312-770-2040
  • Fax: 312-770-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.086373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: