Individual provider Active NPI

Kimberly Jezek-Tisch

  • Obstetrics & Gynecology Physician
  • Chicago, IL
National Provider Identifier
1720090269
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Practice address
1740 W Taylor St
Chicago, IL 60612-7232
Phone
(866) 600-2273
NPI assigned
Aug 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X IL Primary

Addresses

Primary practice location

1740 W Taylor St
Chicago, IL 60612-7232

Mailing address

809 S Marshfield Ave
9TH Floor (M/C 732)
Chicago, IL 60612-4305
Phone (312) 996-7699

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100205000366 IL Practitioner - Certified Nurse Midwife (CNM) 7012050503 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
041-226380ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Obstetrics & Gynecology CurrentSince Jul 1, 2016 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jul 1, 2016 Accepting new patients
The Board of Trustees of the University of Illinois Obstetrics & Gynecology CurrentSince Jul 1, 2016 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients

Locations

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

1740 W Taylor St
Chicago, IL 60612
Phone (312) 355-4000

820 S Wood St
Chicago, IL 60612
Phone (312) 996-6765

1855 W Taylor St
Chicago, IL 60612
Phone (312) 996-6582

809 S Marshfield Ave
Fl 9
Chicago, IL 60612
Phone (312) 996-7699

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720090269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 S MARSHFIELD AVE",
            "address_2": "9TH FLOOR (M/C 732)",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124305",
            "telephone_number": "312-996-7699",
            "fax_number": "312-996-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "866-600-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEZEK-TISCH",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.