MEDICARE: DR. MARKO J JACHTOROWYCZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	036080243	IL
2	207VG0400X	Gynecology Physician	036080243	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073597894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARKO J JACHTOROWYCZ M.D.

Provider Business Mailing Address
First Line	:	5747 DEMPSTER ST
Second Line	:	SUITE 100
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3056
Country	:	US
Telephone Number	:	847-663-1030
Fax Number	:	847-663-1039

Provider Business Practice Location Address
First Line	:	5747 DEMPSTER ST
Second Line	:	SUITE 100
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3056
Country	:	US
Telephone Number	:	847-663-1030
Fax Number	:	847-663-1039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	11/15/2013

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Directions to “ DR. MARKO J JACHTOROWYCZ M.D.” Practice Location

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