Provider Demographics
NPI:1952551517
Name:JANE VERNIK MD, S.C.
Entity Type:Organization
Organization Name:JANE VERNIK MD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-392-3704
Mailing Address - Street 1:4113 FLORENCE WAY
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5631
Mailing Address - Country:US
Mailing Address - Phone:224-392-3704
Mailing Address - Fax:847-375-8279
Practice Address - Street 1:637 SOUTH WOOD STREET ST 215
Practice Address - Street 2:DIVISION OF NEPHROLOGY, DURAND BUILDING
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-864-4612
Practice Address - Fax:312-864-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619352207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty