Provider Demographics
NPI:1598776049
Name:SWEETNER, JONNELLE CARMELITA (MD)
Entity Type:Individual
Prefix:
First Name:JONNELLE
Middle Name:CARMELITA
Last Name:SWEETNER
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 1:1622 ZEPHYR CT
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-5103
Mailing Address - Country:US
Mailing Address - Phone:219-922-2790
Mailing Address - Fax:
Practice Address - Street 1:500 EAST 51ST STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2400
Practice Address - Country:US
Practice Address - Phone:312-572-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089953207R00000X
IN01044215A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089953OtherSTATE LICENSE
IN200907200Medicaid
IN200907200Medicaid
IL036089953OtherSTATE LICENSE