Healthcare Provider Details

I. General information

NPI: 1568146744
Provider Name (Legal Business Name): MARIE JAJOU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N WALL ST STE P310
KANKAKEE IL
60901-3484
US

IV. Provider business mailing address

375 N WALL ST STE P310
KANKAKEE IL
60901-3484
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-0194
  • Fax:
Mailing address:
  • Phone: 815-933-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036180708
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: