Provider Demographics
NPI:1891833075
Name:FEJES, JOLAN (M D)
Entity Type:Individual
Prefix:MS
First Name:JOLAN
Middle Name:
Last Name:FEJES
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6449 S PULASKI RD
Mailing Address - Street 2:SUITE113
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5148
Mailing Address - Country:US
Mailing Address - Phone:773-767-7666
Mailing Address - Fax:773-767-2884
Practice Address - Street 1:6449 S PULASKI RD
Practice Address - Street 2:SUITE113
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5148
Practice Address - Country:US
Practice Address - Phone:773-767-7666
Practice Address - Fax:773-767-2884
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622853OtherBC BS FEP
IL1622853OtherBLUE CROSS BLUE SHIELD
IL1622853OtherBLUE CROSS BLUE SHIELD
IL01622853OtherBC BS FEP