Provider Demographics
NPI:1629158472
Name:KIOKEMEISTER, JAY F (DO)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:F
Last Name:KIOKEMEISTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LBX 809274, PO BOX 809274
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9274
Mailing Address - Country:US
Mailing Address - Phone:773-445-9696
Mailing Address - Fax:773-445-9590
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086579207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG13765Medicare UPIN
ILL96075Medicare ID - Type UnspecifiedCOOK COUNTY
ILL96076Medicare ID - Type UnspecifiedDUPAGE COUNTY