Provider Demographics
NPI:1356549760
Name:JEROME-KON, SCARLINE (MD)
Entity type:Individual
Prefix:DR
First Name:SCARLINE
Middle Name:
Last Name:JEROME-KON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-0800
Mailing Address - Country:US
Mailing Address - Phone:708-338-7400
Mailing Address - Fax:708-338-7057
Practice Address - Street 1:1200 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-0800
Practice Address - Country:US
Practice Address - Phone:708-338-7400
Practice Address - Fax:708-338-7057
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361069242084P0800X
TXS51952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL98572Medicare UPIN