Provider Demographics
NPI:1942227566
Name:SABATH, JENNIFER ANN (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:SABATH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:HAYWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21481 N RAND RD
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3061
Mailing Address - Country:US
Mailing Address - Phone:847-618-9655
Mailing Address - Fax:
Practice Address - Street 1:21481 N RAND RD
Practice Address - Street 2:
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60047-3061
Practice Address - Country:US
Practice Address - Phone:847-618-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107663207Q00000X, 207Q00000X
IL036-107663207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107663Medicaid
IL036107663Medicaid
I31262Medicare UPIN
K34344Medicare PIN
ILK34493Medicare PIN
K34345Medicare PIN