Basic Information
| Provider Information | |||||||||
| NPI: | 1285650838 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JACQUES PAPAZIAN M.D,S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4117 S WATER TOWER PL | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628646567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182420672 | ||||||||
| FaxNumber: | 6182420862 | ||||||||
| Practice Location | |||||||||
| Address1: | 4117 S WATER TOWER PL | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628646293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182420672 | ||||||||
| FaxNumber: | 6182420862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | PAPAZIAN | ||||||||
| AuthorizedOfficialFirstName: | JACQUES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 6182420672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 036093598 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 293973 | 01 | IL | HEALTHLINK PROVIDER ID# | OTHER | 55563 | 01 | IL | GHP PROVIDER ID# | OTHER | 04127654 | 01 | IL | BCBS OF IL PROVIDER# | OTHER | 036093598 | 05 | IL | MEDICAID | 040009944 | 01 | IL | RAILROAD MEDICARE ID# | OTHER | 027794 | 01 | IL | HEALTH ALLIANCE ID# | OTHER |