Provider Demographics
NPI:1467494310
Name:FLEISCHLI, JEFFREY W (DPM)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:W
Last Name:FLEISCHLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 W WALNUT ST STE 12
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-6126
Mailing Address - Country:US
Mailing Address - Phone:800-532-6279
Mailing Address - Fax:
Practice Address - Street 1:1745 W WALNUT ST STE 12
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-6126
Practice Address - Country:US
Practice Address - Phone:800-532-6279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005038213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005038/4974780001OtherMEDICARE DMERC
IL533079/270056166OtherHEALTHLINK PPO
ILRAILROAD MEDICAREOtherP00027608/DA1788
IL06932011OtherBCBS OF ILLINOIS
IL016005038Medicaid
ILHEALTH ALLIANCEOther072022
IL06932011OtherBCBS OF ILLINOIS
ILRAILROAD MEDICAREOtherP00027608/DA1788