Provider Demographics
NPI:1487841904
Name:HAROLD JAIMES, M.D., S.C.
Entity Type:Organization
Organization Name:HAROLD JAIMES, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-395-4600
Mailing Address - Street 1:3153 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2809
Mailing Address - Country:US
Mailing Address - Phone:773-395-4600
Mailing Address - Fax:
Practice Address - Street 1:3800 HIGHLAND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1557
Practice Address - Country:US
Practice Address - Phone:630-719-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAROLD JAIMES, M.D.,S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605620OtherBLUE SHIELD