Provider Demographics
NPI:1760108880
Name:JALK & P LLC
Entity Type:Organization
Organization Name:JALK & P LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:AYEE
Authorized Official - Middle Name:TEAH
Authorized Official - Last Name:BLEEMIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:773-715-7219
Mailing Address - Street 1:6907 ENNIS DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-5603
Mailing Address - Country:US
Mailing Address - Phone:773-715-7219
Mailing Address - Fax:317-659-8825
Practice Address - Street 1:6907 ENNIS DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-5603
Practice Address - Country:US
Practice Address - Phone:773-715-7219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty