Basic Information
| Provider Information | |||||||||
| NPI: | 1598727620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLEJNIK | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 N WESTGATE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626501152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172438455 | ||||||||
| FaxNumber: | 2172437951 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 N WESTGATE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172438455 | ||||||||
| FaxNumber: | 2172437951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 05/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036090909 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 14D1018995 | 01 | IL | CLIA | OTHER | 036090909 | 05 | IL | MEDICAID | 06932015 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 086246 | 01 | IL | HEALTH ALLIANCE | OTHER | 567115 | 01 | IL | HEALTHLINK | OTHER | 086246 | 01 | IL | GROUP HEALTH | OTHER | DC0359 | 01 | IL | RAILROAD MEDICARE GROUP N | OTHER | 200087204 | 01 | IL | IRS TAX ID# | OTHER | 3333333 | 01 | IL | UMWA | OTHER | P00144121 | 01 | IL | RAILROAD MEDICARE PIN # | OTHER |