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General NPI Number Information
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NPI Number | 1467402388
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Entity Type | Individual
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Provider Name | JASON JOHN JERISHA DPM
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 775 WAUKEGAN RD SUITE 200
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City | DEERFIELD
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State | IL
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Zip | 60015-4342
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Country | US
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Telephone | 800-317-0711
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Fax | 800-434-7113
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Provider Business Mailing Address
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Address Line | 232 ARBORS PKWY W NUMBER 22
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City | FINDLAY
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State | OH
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Zip | 45840-8741
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Country | US
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Telephone | 419-425-1901
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Fax | 419-427-2688
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36-003416
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License Number State | OH
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