Provider Demographics
NPI:1952361164
Name:MEJIA, JAIRO ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIRO
Middle Name:ALBERTO
Last Name:MEJIA
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 1:2533 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3719
Mailing Address - Country:US
Mailing Address - Phone:773-523-0900
Mailing Address - Fax:773-523-9168
Practice Address - Street 1:2533 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3719
Practice Address - Country:US
Practice Address - Phone:773-523-0900
Practice Address - Fax:773-523-9168
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-112606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN
ILI37777Medicare UPIN