MEDICARE: DR. JAY KIOKEMEISTER

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	208VP0014X	Interventional Pain Medicine Physician	0360866579	IL

General Provider Information

NPI Number	:	1982986790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JAY KIOKEMEISTER

Provider Business Mailing Address
First Line	:	801 N CASS AVE
Second Line	:	SUITE 202
City	:	WESTMONT
State	:	IL
Zip	:	60559-1756
Country	:	US
Telephone Number	:	163-092-0820
Fax Number	:	163-092-0823

Provider Business Practice Location Address
First Line	:	801 N CASS AVE
Second Line	:	SUITE 202
City	:	WESTMONT
State	:	IL
Zip	:	60559-1756
Country	:	US
Telephone Number	:	163-092-0820
Fax Number	:	163-092-0823

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAY F KIOKEMEISTER
Credential	:	D.O.
Telephone Number	:	18478948176

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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