Provider Demographics
NPI:1083693428
Name:MONESTERSKY, JESSE HARRIS (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:HARRIS
Last Name:MONESTERSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JESSE
Other - Middle Name:H
Other - Last Name:MONESTERSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:240 E PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2521
Mailing Address - Country:US
Mailing Address - Phone:847-234-0306
Mailing Address - Fax:
Practice Address - Street 1:3001A SIXTH STREET
Practice Address - Street 2:NAVAL HEALTH CLINIC GREAT LAKES
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILVAD0000Medicare UPIN