MEDICARE: DR. PAUL J JAGIELO MD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036092726	IL
2	207RP1001X	Pulmonary Disease Physician	036092726	IL
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	036092726	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1615809	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457338626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J JAGIELO MD

Provider Business Mailing Address
First Line	:	700 E OGDEN AVE
Second Line	:	STE 202
City	:	WESTMONT
State	:	IL
Zip	:	60559-5569
Country	:	US
Telephone Number	:	630-789-9785
Fax Number	:	630-789-9798

Provider Business Practice Location Address
First Line	:	700 E OGDEN AVE
Second Line	:	STE 202
City	:	WESTMONT
State	:	IL
Zip	:	60559-5569
Country	:	US
Telephone Number	:	630-789-9785
Fax Number	:	630-789-9798

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	05/11/2009

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Directions to “ DR. PAUL J JAGIELO MD” Practice Location

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