Provider Demographics
NPI:1235221722
Name:JAFFE, GITIE S (MD)
Entity Type:Individual
Prefix:
First Name:GITIE
Middle Name:S
Last Name:JAFFE
Suffix:
Gender:F
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:PO BOX 88487
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-1487
Mailing Address - Country:US
Mailing Address - Phone:312-791-2000
Mailing Address - Fax:312-791-2076
Practice Address - Street 1:5454 HOFFMAN AVE
Practice Address - Street 2:SAINT MARGARET MERCY HEALTHCARE CENTERS
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1999
Practice Address - Country:US
Practice Address - Phone:708-891-9305
Practice Address - Fax:219-933-2597
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057469A207ZP0102X
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN036087621-1Medicaid
G13722Medicare UPIN
IN036087621-1Medicaid