MEDICARE: BARBARA JACKS 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	207RR0500X	Rheumatology Physician		IL

General Provider Information

NPI Number	:	1548230451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JACKS MD

Provider Business Mailing Address
First Line	:	150 E HURON ST
Second Line	:	SUITE 805
City	:	CHICAGO
State	:	IL
Zip	:	60611-2999
Country	:	US
Telephone Number	:	773-404-0160
Fax Number	:	773-404-9876

Provider Business Practice Location Address
First Line	:	150 E HURON ST
Second Line	:	SUITE 805
City	:	CHICAGO
State	:	IL
Zip	:	60611-2999
Country	:	US
Telephone Number	:	773-404-0160
Fax Number	:	773-404-9876

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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