Provider Demographics
NPI:1487674693
Name:DASZKO, JAROM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAROM
Middle Name:
Last Name:DASZKO
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 1:6101 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2735
Mailing Address - Country:US
Mailing Address - Phone:708-261-0831
Mailing Address - Fax:773-790-4077
Practice Address - Street 1:6101 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2735
Practice Address - Country:US
Practice Address - Phone:708-261-0831
Practice Address - Fax:773-790-4077
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF43089Medicare UPIN
CA00G728600Medicare ID - Type Unspecified