Provider Demographics
NPI:1770526279
Name:JAIMES, HAROLD (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:JAIMES
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 1:3153 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088816Medicaid
IL110141147OtherRAILROAD MEDICARE
IL1605620OtherBLUE SHIELD
IL210172Medicare ID - Type Unspecified
IL036088816Medicaid