Provider Demographics
NPI:1932400041
Name:JILL A. PATTERSON, MD, S.C.
Entity Type:Organization
Organization Name:JILL A. PATTERSON, MD, S.C.
Other - Org Name:GENERATION MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-478-5763
Mailing Address - Street 1:11148 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1525
Mailing Address - Country:US
Mailing Address - Phone:708-478-5763
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:11148 FRONT ST
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1525
Practice Address - Country:US
Practice Address - Phone:708-478-5763
Practice Address - Fax:630-914-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084102261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1083642557Medicare UPIN