Healthcare Provider Details

I. General information

NPI: 1992966451
Provider Name (Legal Business Name): JILL JUDITH VESELIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE DEPARTMENT OF PEDIATRICS
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

1040 W ADAMS ST UNIT 411
CHICAGO IL
60607-2998
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-9000
  • Fax:
Mailing address:
  • Phone: 630-404-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125051019
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036122664
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: