Provider Demographics
NPI:1184794281
Name:JANKELOWITZ, LARRY M (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:JANKELOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7447 W. TALCOTT AVE.
Mailing Address - Street 2:SUITE 542
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-6716
Mailing Address - Country:US
Mailing Address - Phone:773-631-2180
Mailing Address - Fax:773-631-5947
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 542
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-2180
Practice Address - Fax:773-631-5947
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036101642207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101642Medicaid
H83607Medicare UPIN
L98488Medicare ID - Type Unspecified