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General NPI Number Information
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NPI Number | 1639564115
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Entity Type | Individual
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Provider Name | JOHN NICHOLAS JESSE III M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 836 W WELLINGTON AVE
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City | CHICAGO
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State | IL
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Zip | 60657-5147
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Country | US
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Telephone | 773-296-3563
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Fax | 458-217-7768
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Provider Business Mailing Address
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Address Line | 836 W WELLINGTON AVE
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City | CHICAGO
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State | IL
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Zip | 60657-5147
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Country | US
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Telephone | 773-296-3563
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Fax | 458-217-7768
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 036.157267
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | 036.157267
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 67902-20
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036.157267
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License Number State | IL
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