Poole, Jerry Matthew

Poole, Jerry Matthew is an individual health care provider with primary practice located at 40 Skokie Blvd Ste 520 , Northbrook IL 60062-1601. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Poole, Jerry Matthew can be contacted via phone (847) 504-5000.

Contact Information

Primary practice address
40 Skokie Blvd Ste 520 Northbrook IL 60062-1601
Phone: (847) 504-5000
Fax: (847) 504-5015
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 886-25 Wisconsin

Profile Details

NPI number 1710952999
LBN Legal business name Poole, Jerry Matthew
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 21st, 2006
Last updated Jan 22nd, 2019 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710952999 NPPES
Wisconsin MEDICAID 1710952999
Wisconsin Other P01615149
Wisconsin Other P01743256

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