Provider Demographics
NPI:1588015416
Name:THEKKEKARA, JAISON J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAISON
Middle Name:J
Last Name:THEKKEKARA
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 1:329 REMINGTON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5817
Mailing Address - Country:US
Mailing Address - Phone:630-226-1130
Mailing Address - Fax:630-226-1134
Practice Address - Street 1:329 REMINGTON BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5817
Practice Address - Country:US
Practice Address - Phone:630-226-1130
Practice Address - Fax:630-226-1134
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.112625207L00000X
IL036152336207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology