Provider Demographics
NPI:1821166059
Name:OEHLER, JASON W
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:OEHLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 DEERFIELD RD
Mailing Address - Street 2:SUITE 100 PMB 418
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3241
Mailing Address - Country:US
Mailing Address - Phone:708-681-7888
Mailing Address - Fax:708-681-7327
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-681-7888
Practice Address - Fax:708-681-7327
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002383363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085002383OtherSTATE LICENSE
ILDEAOtherMO 11900400
ILDEAOtherMO 11900400