Provider Demographics
NPI:1972530574
Name:ADAMS-BAILEY, JURA M (MD)
Entity Type:Individual
Prefix:
First Name:JURA
Middle Name:M
Last Name:ADAMS-BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JURA
Other - Middle Name:M
Other - Last Name:MIDIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD:
Mailing Address - Street 1:410 W. WISCONSIN STREET
Mailing Address - Street 2:UNIT F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:312-440-8853
Mailing Address - Fax:312-440-8863
Practice Address - Street 1:3405 N. KENNICOTT AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-483-0303
Practice Address - Fax:847-483-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360645742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064Medicaid
IL31603305OtherBLUE SHIELD
E31008Medicare UPIN
IL201931Medicare ID - Type Unspecified
IL31603305OtherBLUE SHIELD