Basic Information
| Provider Information | |||||||||
| NPI: | 1902985013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JICK | ||||||||
| FirstName: | JAMEY | ||||||||
| MiddleName: | JILL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | N14W23900 STONE RIDGE DR | ||||||||
| Address2: | PROHEALTH CARE MEDICAL ASSOCIATES | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625493030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | N14W23900 STONE RIDGE DR | ||||||||
| Address2: | PROHEALTH CARE MEDICAL ASSOCIATES | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625493030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 49790-020 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.