MEDICARE: JEFFERY D. SEMEL 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	207RI0200X	Infectious Disease Physician	036050151	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	440003493	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4929938	OTHER	IL	BCBS PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659367837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY D. SEMEL MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE
Second Line	:	BURCH 118, EVANSTON HOSPITAL
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-1502
Fax Number	:	847-733-5331

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE
Second Line	:	BURCH 118, EVANSTON HOSPITAL
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-1502
Fax Number	:	847-733-5331

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	10/13/2020

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Directions to “ JEFFERY D. SEMEL MD” Practice Location

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