Provider Demographics
NPI:1982350153
Name:TOLBERT, JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD JEREMY TOLBERT
Mailing Address - Street 1:14500 OAKLEY ST
Mailing Address - Street 2:
Mailing Address - City:DIXMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60426-1056
Mailing Address - Country:US
Mailing Address - Phone:773-426-2318
Mailing Address - Fax:
Practice Address - Street 1:14500 OAKLEY ST
Practice Address - Street 2:
Practice Address - City:DIXMOOR
Practice Address - State:IL
Practice Address - Zip Code:60426-1056
Practice Address - Country:US
Practice Address - Phone:773-426-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9166763412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist