Provider Demographics
NPI:1255561510
Name:TYMOUCH, JAROSLAV (MD)
Entity type:Individual
Prefix:
First Name:JAROSLAV
Middle Name:
Last Name:TYMOUCH
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 1:619 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1101
Mailing Address - Country:US
Mailing Address - Phone:773-398-3351
Mailing Address - Fax:
Practice Address - Street 1:2515 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4516
Practice Address - Country:US
Practice Address - Phone:773-697-7946
Practice Address - Fax:312-864-9542
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116592207L00000X
IL036116592207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology