Provider Demographics
NPI:1598727620
Name:OLEJNIK, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:OLEJNIK
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 1:610 N WESTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1152
Mailing Address - Country:US
Mailing Address - Phone:217-243-8455
Mailing Address - Fax:217-243-7951
Practice Address - Street 1:610 N WESTGATE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650
Practice Address - Country:US
Practice Address - Phone:217-243-8455
Practice Address - Fax:217-243-7951
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090909207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D1018995OtherCLIA
IL036090909Medicaid
IL06932015OtherBLUE CROSS BLUE SHIELD
IL086246OtherHEALTH ALLIANCE
IL567115OtherHEALTHLINK
IL086246OtherGROUP HEALTH
ILDC0359OtherRAILROAD MEDICARE GROUP N
IL200087204OtherIRS TAX ID#
IL3333333OtherUMWA
ILP00144121OtherRAILROAD MEDICARE PIN #