Healthcare Provider Details

I. General information

NPI: 1629378096
Provider Name (Legal Business Name): JAKE TABEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 NATIONAL PKWY
SCHAUMBURG IL
60173-5161
US

IV. Provider business mailing address

955 NATIONAL PKWY
SCHAUMBURG IL
60173-5161
US

V. Phone/Fax

Practice location:
  • Phone: 847-884-9440
  • Fax:
Mailing address:
  • Phone: 847-884-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036132237
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: