Provider Demographics
NPI:1770028664
Name:TIU, JEROME FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:JEROME FRANCIS
Middle Name:
Last Name:TIU
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 1:1650 W HARRISON ST
Mailing Address - Street 2:STE 466
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3800
Mailing Address - Country:US
Mailing Address - Phone:312-912-4458
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0697312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry