Healthcare Provider Details

I. General information

NPI: 1447457585
Provider Name (Legal Business Name): JEFFERY JOHN KAMYSZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S ROSELLE RD 2ND FLOOR
SCHAUMBURG IL
60193-3175
US

IV. Provider business mailing address

5514 W ARDMORE AVE
CHICAGO IL
60646-6506
US

V. Phone/Fax

Practice location:
  • Phone: 312-420-8414
  • Fax:
Mailing address:
  • Phone: 847-477-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036-083315
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036083315
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.083315
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: