Provider Demographics
NPI:1033438973
Name:JAITOVICH, ADOLFO ARIEL (MD)
Entity Type:Individual
Prefix:
First Name:ADOLFO
Middle Name:ARIEL
Last Name:JAITOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N LAKE SHORE DR APT 11C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6637
Mailing Address - Country:US
Mailing Address - Phone:312-933-8965
Mailing Address - Fax:
Practice Address - Street 1:1900 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3736
Practice Address - Country:US
Practice Address - Phone:312-864-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine