Provider Demographics
NPI:1932287315
Name:JARAMILLO, JANNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JANNETH
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANNETH
Other - Middle Name:
Other - Last Name:JARAMILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2610 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2850
Mailing Address - Country:US
Mailing Address - Phone:773-227-3232
Mailing Address - Fax:773-227-2898
Practice Address - Street 1:2610 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2850
Practice Address - Country:US
Practice Address - Phone:773-227-3232
Practice Address - Fax:773-227-2898
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100957Medicaid
IL01626610OtherBLUE CROSS SHIELD
586520Medicare ID - Type Unspecified
IL036100957Medicaid