Provider Demographics
NPI:1295775146
Name:HAROLD JAIMES, M.D. P.C
Entity type:Organization
Organization Name:HAROLD JAIMES, M.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-395-4600
Mailing Address - Street 1:3153 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2809
Mailing Address - Country:US
Mailing Address - Phone:773-395-4600
Mailing Address - Fax:773-395-4633
Practice Address - Street 1:3153 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2809
Practice Address - Country:US
Practice Address - Phone:773-395-4600
Practice Address - Fax:773-395-4633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAROLD JAIMES, M.D.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605620OtherBLUE SHIELD
IL210172Medicare ID - Type Unspecified