Provider Demographics
NPI:1881727063
Name:ROSS, JEFFREY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEVEN
Last Name:ROSS
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 1:3085 PHEASANT CREEK DR
Mailing Address - Street 2:#203
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3362
Mailing Address - Country:US
Mailing Address - Phone:847-484-1812
Mailing Address - Fax:847-400-5828
Practice Address - Street 1:666 DUNDEE RD
Practice Address - Street 2:SUITE 1302
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2727
Practice Address - Country:US
Practice Address - Phone:847-484-1812
Practice Address - Fax:847-400-5828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31604387OtherBCBS PROVIDER NUMBER
ILF32760Medicare UPIN
IL982420Medicare ID - Type Unspecified