Active NPI
Andre T Dejean /Dejean Wellness
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1952532426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036098449
- Legal business name
- ANDRE T DEJEAN /DEJEAN WELLNESS
- Practice address
- 9040 S Merrill Ave
Chicago, IL 60617-3811 - Phone
- (773) 620-9864
- Fax
- (866) 261-3402
- NPI assigned
- Aug 2, 2009
- Last updated
- Aug 2, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Andre T Dejean, MD
- Title
- Physician
- Phone
- (773) 620-9864
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036098449 | IL | Primary |
Addresses
Primary practice location
9040 S Merrill Ave
Chicago, IL 60617-3811
Mailing address
9040 S Merrill Ave
Chicago, IL 60617-3811
Phone (773) 620-9864
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639140700 | Other | IL | NPI |
| 036098449 | Medicaid | IL |
National Provider Directory
National Provider Directory- Tax ID family
- Andre T Dejean Dejean Wellness
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Chicago, IL
- NPI 1255564316
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Family Medicine Physician
- Bakersfield, CA
- NPI 1639140700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249171200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1249171200000",
"number": "1952532426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9040 S MERRILL AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606173811",
"telephone_number": "773-620-9864",
"fax_number": "866-261-3402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 S MERRILL AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606173811",
"telephone_number": "773-620-9864",
"fax_number": "866-261-3402"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANDRE T DEJEAN /DEJEAN WELLNESS",
"organizational_subpart": "NO",
"enumeration_date": "2009-08-02",
"last_updated": "2009-08-02",
"status": "A",
"authorized_official_last_name": "DEJEAN",
"authorized_official_first_name": "ANDRE",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "PHYSICIAN",
"authorized_official_telephone_number": "773-620-9864",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036098449",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1639140700",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036098449",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.