Provider Demographics
NPI:1952604795
Name:COSMOPOLITAN HEALTH CARE SERVICES SC
Entity Type:Organization
Organization Name:COSMOPOLITAN HEALTH CARE SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKIMIEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-590-1500
Mailing Address - Street 1:3328 N. HARLME AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:847-590-1500
Mailing Address - Fax:
Practice Address - Street 1:1655 N. ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 203E
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-590-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095319Medicaid
IL399470Medicare PIN