Provider Demographics
NPI:1780680330
Name:FIREMAN, JEFFREY EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EDWARD
Last Name:FIREMAN
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 1:2010 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4134
Mailing Address - Country:US
Mailing Address - Phone:847-758-2080
Mailing Address - Fax:847-758-2084
Practice Address - Street 1:2010 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4134
Practice Address - Country:US
Practice Address - Phone:847-758-2080
Practice Address - Fax:847-758-2084
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-062549208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-06549Medicaid
IL175093Medicare PIN