Provider Demographics
NPI:1609936954
Name:DRAG, JAROSLAW K (MD)
Entity Type:Individual
Prefix:DR
First Name:JAROSLAW
Middle Name:K
Last Name:DRAG
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 1:1144 S ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-4072
Mailing Address - Country:US
Mailing Address - Phone:847-524-3200
Mailing Address - Fax:847-524-3300
Practice Address - Street 1:1144 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-4072
Practice Address - Country:US
Practice Address - Phone:847-524-3200
Practice Address - Fax:847-524-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL566840 L74945Medicare PIN
ILG73670Medicare UPIN