Provider Demographics
NPI:1255325676
Name:JABBOUR, JEROME ANTOUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ANTOUN
Last Name:JABBOUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:600 N MCCLURG CT
Mailing Address - Street 2:3806 A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3044
Mailing Address - Country:US
Mailing Address - Phone:248-802-3842
Mailing Address - Fax:248-802-3842
Practice Address - Street 1:2310 YORK ST
Practice Address - Street 2:SUITE 2 C
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2411
Practice Address - Country:US
Practice Address - Phone:773-809-3622
Practice Address - Fax:773-409-8659
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01060708A207Q00000X
IL036119492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200525220Medicaid
IN200525220Medicaid
INI36710Medicare UPIN