Provider Demographics
NPI:1346403821
Name:DEJONG, MEGAN JOY (MD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:JOY
Last Name:DEJONG
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 1:12251 S. 80TH AVENUE, SUITE 1630
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1256
Mailing Address - Country:US
Mailing Address - Phone:708-590-5304
Mailing Address - Fax:708-590-5308
Practice Address - Street 1:15300 WEST AVE, SUITE 120
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-590-5304
Practice Address - Fax:708-590-5308
Is Sole Proprietor?:No
Enumeration Date:2008-07-06
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.131076207V00000X
IL036131076208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036131076Medicaid
IL036131076Medicaid