=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689092793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN JASONOWICZ D.P.M
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2014
-----------------------------------------------------
Last Update Date | 07/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27401 W HIGHWAY 22 STE 125
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60010-5934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-381-0388
-----------------------------------------------------
Fax | 847-381-0811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 RAND ROAD SUITE 300
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-324-3976
-----------------------------------------------------
Fax | 847-929-1154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 016005684
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 016005684
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------