Provider Demographics
NPI:1053041558
Name:DR. JABER PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:DR. JABER PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-725-6226
Mailing Address - Street 1:1106 N LARKIN AVE UPPR LEVEL
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3455
Mailing Address - Country:US
Mailing Address - Phone:815-725-6226
Mailing Address - Fax:
Practice Address - Street 1:1106 N LARKIN AVE UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3455
Practice Address - Country:US
Practice Address - Phone:815-725-6226
Practice Address - Fax:815-725-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076060Medicaid