Healthcare Provider Details

I. General information

NPI: 1417063041
Provider Name (Legal Business Name): JEFFREY A. CABOTAJE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/15/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6853 NORTH AVE
OAK PARK IL
60302-1023
US

IV. Provider business mailing address

6853 NORTH AVE
OAK PARK IL
60302-1023
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-3010
  • Fax: 708-383-6475
Mailing address:
  • Phone: 708-383-3010
  • Fax: 708-393-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-105051
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: