Provider Demographics
NPI:1366491193
Name:PAPAZIAN, JACQUES (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:
Last Name:PAPAZIAN
Suffix:
Gender:M
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 1389
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0028
Mailing Address - Country:US
Mailing Address - Phone:618-242-0672
Mailing Address - Fax:618-242-0862
Practice Address - Street 1:4117 S WATER TOWER PL
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6293
Practice Address - Country:US
Practice Address - Phone:618-242-0672
Practice Address - Fax:618-242-0862
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04127654OtherBCBS OF IL PROVIDER ID#
IL293973OtherHEALTHLINK PROVIDER ID#
IL027794OtherHEALTH ALLIANCE ID#
IL55563OtherGHP PROVIDER ID#
IL027794OtherHEALTH ALLIANCE ID#
ILG36787Medicare UPIN