Provider Demographics
NPI:1063648632
Name:FLEISHER, JONAH D (MD)
Entity Type:Individual
Prefix:DR
First Name:JONAH
Middle Name:D
Last Name:FLEISHER
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 1:820 S WOOD ST, M/C 808
Mailing Address - Street 2:DEPARTMENT OF OBSTETRICS & GYNECOLOGY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-413-7500
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST, M/C 650
Practice Address - Street 2:OUTPATIENT CARE CENTER, SUITE 4C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-413-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449108207V00000X
NY274112207V00000X
IL036.143320207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1028348820001Medicaid