Provider Demographics
NPI:1518053826
Name:HAIMES, JACQUELINE (MD)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:HAIMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 SHERMAN AVENUE
Mailing Address - Street 2:#210
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-328-4000
Mailing Address - Fax:847-328-4953
Practice Address - Street 1:1718 SHERMAN AVENUE
Practice Address - Street 2:#210
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-328-4000
Practice Address - Fax:847-328-4953
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633883OtherBCBS PPO