Provider Demographics
NPI:1225068117
Name:DEBRA L. JARYSZAK, M.D., LLC
Entity Type:Organization
Organization Name:DEBRA L. JARYSZAK, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JARYSZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-531-8800
Mailing Address - Street 1:1975 LIN LOR LN
Mailing Address - Street 2:SUITE 195
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4902
Mailing Address - Country:US
Mailing Address - Phone:847-531-8800
Mailing Address - Fax:847-531-8680
Practice Address - Street 1:1975 LIN LOR LN
Practice Address - Street 2:SUITE 195
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4902
Practice Address - Country:US
Practice Address - Phone:847-531-8800
Practice Address - Fax:847-531-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532167OtherBLUE CROSS BLUE SHIELD
IL04532167OtherBLUE CROSS BLUE SHIELD