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General NPI Number Information
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NPI Number | 1144398520
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Entity Type | Individual
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Provider Name | ALAN JACKSON MD
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 2734 W 87TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-3937
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Country | US
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Telephone | 773-918-4700
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Fax | 773-313-3763
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Provider Business Mailing Address
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Address Line | 2734 W 87TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-3937
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Country | US
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Telephone | 773-918-4700
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Fax | 773-313-3763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036081595
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License Number State | IL
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