Jefferson, Theodore B
Jefferson, Theodore B is an individual health care provider with primary practice located at 11043 Quail Dr , Mokena IL 60448-8286. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jefferson, Theodore B can be contacted via phone (708) 303-2789.Contact Information
Primary practice address
11043 Quail Dr
Mokena IL 60448-8286
Phone: (708) 303-2789
Fax: (708) 300-4772
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 36-112824 | Illinois |
Profile Details
| NPI number | 1568495091 |
|---|---|
| LBN Legal business name | Jefferson, Theodore B |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 8th, 2006 |
| Last updated | Mar 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568495091 | NPPES |
| Illinois | MEDICAID | 036112824 | |
| Illinois | Other | K17486 |
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