Provider Demographics
NPI:1720317910
Name:SPITZ, JAMIE (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SPITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1875 DEMPSTER ST STE 640
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1179
Mailing Address - Country:US
Mailing Address - Phone:847-297-6380
Mailing Address - Fax:847-297-0589
Practice Address - Street 1:1875 DEMPSTER ST STE 640
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1179
Practice Address - Country:US
Practice Address - Phone:847-297-6380
Practice Address - Fax:847-297-0589
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35133375208200000X
IL036137616208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0302314Medicaid