Provider Demographics
NPI:1902873722
Name:PARNELL, JEFFREY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:PARNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3714
Mailing Address - Country:US
Mailing Address - Phone:847-972-2700
Mailing Address - Fax:847-972-2711
Practice Address - Street 1:7447 W TALCOTT AVE STE 345
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3714
Practice Address - Country:US
Practice Address - Phone:847-972-2700
Practice Address - Fax:847-972-2712
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095676207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1637185OtherBLUE CROSS BLUE SHIELD
IL036095676 03Medicaid
IL036095676 02Medicaid
ILP00365660OtherMEDICARE RAILROAD CARRIER
IL1615858OtherBLUE CROSS BLUE SHIELD
IL1615858OtherBLUE CROSS BLUE SHIELD
ILG90571Medicare UPIN
ILK34986Medicare PIN
ILL72330Medicare PIN
ILL72329Medicare PIN