Marvin William Jackson, MD, MS

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

036.122582 Issued in IL

Practice address

2300 E Devon Ave
Suite 427
Des Plaines, IL 60018-4696

Phone

(847) 294-7795

Fax

(847) 294-7808

NPI assigned

Aug 8, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine, Master of Science

State licenses

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

{
    "created_epoch": "1375920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375920000000",
    "number": "1760814040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 E DEVON AVE",
            "address_2": "SUITE 427",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600184696",
            "telephone_number": "847-294-7795",
            "fax_number": "847-294-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 E DEVON AVE",
            "address_2": "SUITE 427",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600184696",
            "telephone_number": "847-294-7795",
            "fax_number": "847-294-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARVIN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "MD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-08",
        "last_updated": "2013-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "IL",
            "license": "036.122582",
            "primary": true
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "OH",
            "license": "35.085150",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Therapy Specialists, L.L.C.
• Amy Larisa Isenberg
• Vicki Lynn Ivins, M.S., CCC-SLP
• Madhu Mia Iyer, DC
• Mohammed Saim Jabbar, D.D.S.
• Ann Elizabeth Jacob, PHARM D
• Gregory S Jacob, DDS
• William Louis Jacobs
• Michelle Lynn Jacobsberg
• Samarjit S Jaglan, M.D.

• Aerospace Medicine Physician in Des Plaines, IL
• Providers in Des Plaines, IL by specialty
• Aerospace Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2013; 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.