Healthcare Provider Details

I. General information

NPI: 1184693111
Provider Name (Legal Business Name): JONATHAN SPERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N MAIN ST
MIDDLEBURY IN
46540-9218
US

IV. Provider business mailing address

1560 WALL ST STE 335
NAPERVILLE IL
60563-1267
US

V. Phone/Fax

Practice location:
  • Phone: 630-730-0364
  • Fax: 630-206-1255
Mailing address:
  • Phone: 630-730-0364
  • Fax: 630-206-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-108385
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036108385
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: