Provider Demographics
NPI:1982676342
Name:SECKLER, JERROLD HOWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:JERROLD
Middle Name:HOWARD
Last Name:SECKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W. CENTRAL ROAD
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-259-2410
Mailing Address - Fax:847-259-8603
Practice Address - Street 1:880 W. CENTRAL ROAD
Practice Address - Street 2:SUITE 5200
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-259-2410
Practice Address - Fax:847-259-8603
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047545208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615843OtherBCBS
ILC42156Medicaid
C42156Medicare UPIN
ILL37321Medicare ID - Type Unspecified