Provider Demographics
NPI:1487044335
Name:LAUREN JACKER MD LLC
Entity Type:Organization
Organization Name:LAUREN JACKER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-831-9304
Mailing Address - Street 1:1893 SHERIDAN RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2628
Mailing Address - Country:US
Mailing Address - Phone:847-831-9304
Mailing Address - Fax:847-831-9594
Practice Address - Street 1:1893 SHERIDAN RD
Practice Address - Street 2:SUITE 303
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2628
Practice Address - Country:US
Practice Address - Phone:847-831-9304
Practice Address - Fax:847-831-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360656042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100197617Medicare PIN