Provider Demographics
NPI:1578928719
Name:JAROS, LUKASZ
Entity Type:Individual
Prefix:MR
First Name:LUKASZ
Middle Name:
Last Name:JAROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST STE 2150
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3370
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-926-3858
Practice Address - Street 1:259 E ERIE ST STE 2150
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3370
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-926-3858
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.075569207Q00000X
IL125075569207Q00000X
IL390200000X
IL036166273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program