Tim M. Jackimek, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

019020036 Issued in IL

Practice address

4343 Old Grand Ave
Ste # 105
Gurnee, IL 60031-2767

Phone

(847) 662-0330

NPI assigned

Feb 10, 2007

Last updated

Sep 18, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442534400000",
    "number": "1326189309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 OLD GRAND AVE",
            "address_2": "STE 105",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312767",
            "telephone_number": "847-662-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 OLD GRAND AVE",
            "address_2": "STE # 105",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312767",
            "telephone_number": "847-662-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKIMEK",
        "first_name": "TIM",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-10",
        "last_updated": "2015-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019020036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ira J Piel MD Facp SC
• Mareen Itty, MOT
• Pavel Ivanchenko, RBT
• Linda Ann Ivers, PT
• Henrietta Ann Ivy
• Brian Jackson
• Donna Marie Jackson, MSW, LSW, CDP
• Justin S Jacob, PHARMD
• Charles E Jaffe, DO
• Peter Eriq Jaffe

• Dentist in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.