Provider Demographics
NPI:1982986790
Name:DR. JAY KIOKEMEISTER
Entity Type:Organization
Organization Name:DR. JAY KIOKEMEISTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIOKEMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:1847-894-8176
Mailing Address - Street 1:801 N CASS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1756
Mailing Address - Country:US
Mailing Address - Phone:163-092-0820
Mailing Address - Fax:163-092-0823
Practice Address - Street 1:801 N CASS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1756
Practice Address - Country:US
Practice Address - Phone:163-092-0820
Practice Address - Fax:163-092-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360866579208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL96075Medicare UPIN