1033150644 NPI number — MRS. DEBORAH BISHOP JEFFERSON APN

Table of content: MRS. DEBORAH BISHOP JEFFERSON APN (NPI 1033150644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033150644 NPI number — MRS. DEBORAH BISHOP JEFFERSON APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEFFERSON
Provider First Name:
DEBORAH
Provider Middle Name:
BISHOP
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BISHOP
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033150644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1339 W ALBION AVE
Provider Second Line Business Mailing Address:
#2W
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60626-4701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-973-0393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 N CHILDRENS PLZ
Provider Second Line Business Practice Location Address:
DIVISION OF CARDIOLOGY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-3363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-880-6957
Provider Business Practice Location Address Fax Number:
773-880-8111
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  209005152 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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