Provider Demographics
NPI:1073597894
Name:JACHTOROWYCZ, MARKO J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARKO
Middle Name:J
Last Name:JACHTOROWYCZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5747 DEMPSTER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3056
Mailing Address - Country:US
Mailing Address - Phone:847-663-1030
Mailing Address - Fax:847-663-1039
Practice Address - Street 1:5747 DEMPSTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3056
Practice Address - Country:US
Practice Address - Phone:847-663-1030
Practice Address - Fax:847-663-1039
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036080243207VF0040X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036080243Medicaid
ILF28788Medicare UPIN
IL036080243Medicaid