Provider Demographics
NPI:1821215799
Name:JCARE LTD
Entity type:Organization
Organization Name:JCARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WAITKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-238-0627
Mailing Address - Street 1:11860 S BELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4720
Mailing Address - Country:US
Mailing Address - Phone:773-238-0627
Mailing Address - Fax:773-884-8065
Practice Address - Street 1:2701 W 68TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1813
Practice Address - Country:US
Practice Address - Phone:773-884-7983
Practice Address - Fax:773-884-8065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632716OtherBLUE CROSS BLUE SHIELD
IL01632716OtherBLUE CROSS BLUE SHIELD
IL202770Medicare ID - Type UnspecifiedMEDICARE PROVIDER #