Provider Demographics
NPI:1447457585
Name:KAMYSZ, JEFFERY JOHN (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:JOHN
Last Name:KAMYSZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 W ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6506
Mailing Address - Country:US
Mailing Address - Phone:847-477-8029
Mailing Address - Fax:
Practice Address - Street 1:621 S ROSELLE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3175
Practice Address - Country:US
Practice Address - Phone:312-420-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-083315207ZP0102X
IL036083315207Q00000X
IL036.083315208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF36789Medicare UPIN
ILKA0748571Medicare ID - Type Unspecified