Provider Demographics
NPI:1407832967
Name:ITKONEN, JARMO J (MD)
Entity Type:Individual
Prefix:
First Name:JARMO
Middle Name:J
Last Name:ITKONEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18141 DIXIE HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2238
Mailing Address - Country:US
Mailing Address - Phone:708-799-8440
Mailing Address - Fax:708-799-8446
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-331-0408
Practice Address - Fax:708-331-8164
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036060989207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
290001113AOtherRR MEDICARE
IL31601092OtherBLUE SHIELD
IL036060989Medicaid
290001113AOtherRR MEDICARE
IL532500Medicare ID - Type Unspecified