MEDICARE: MR. JERROLD HOWARD SECKLER 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	208800000X	Urology Physician	036047545	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1615843	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982676342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERROLD HOWARD SECKLER M.D.

Provider Business Mailing Address
First Line	:	880 W. CENTRAL ROAD
Second Line	:	SUITE 5200
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005
Country	:	US
Telephone Number	:	847-259-2410
Fax Number	:	847-259-8603

Provider Business Practice Location Address
First Line	:	880 W. CENTRAL ROAD
Second Line	:	SUITE 5200
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005
Country	:	US
Telephone Number	:	847-259-2410
Fax Number	:	847-259-8603

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	08/26/2010

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