Provider Demographics
NPI:1205019106
Name:JEFFREY S. WAITZMAN, M.D.,S.C.
Entity Type:Organization
Organization Name:JEFFREY S. WAITZMAN, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:I
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-698-0400
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:SUITE 265
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-698-0400
Mailing Address - Fax:847-698-0407
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 265
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-698-0400
Practice Address - Fax:847-698-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601976OtherBLUE CROSS BLUE SHIELD
IL222090Medicare PIN
IL31601976OtherBLUE CROSS BLUE SHIELD