Provider Demographics
NPI:1508078239
Name:FATIMA JAFFER MD SC PC
Entity Type:Organization
Organization Name:FATIMA JAFFER MD SC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-789-3133
Mailing Address - Street 1:PO BOX 5758
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5308
Mailing Address - Country:US
Mailing Address - Phone:630-789-3133
Mailing Address - Fax:630-789-3379
Practice Address - Street 1:PHYSICIANS PAVILION SUITE 101
Practice Address - Street 2:24 EAST JOLIET STREET
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311
Practice Address - Country:US
Practice Address - Phone:219-865-2141
Practice Address - Fax:219-864-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044403A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000353010OtherBLUE CROSS BLUE SHIELD
IN224030Medicare ID - Type Unspecified
IN000000353010OtherBLUE CROSS BLUE SHIELD