Provider Demographics
NPI:1144273897
Name:KOVELESKI, JULES T (MD)
Entity type:Individual
Prefix:DR
First Name:JULES
Middle Name:T
Last Name:KOVELESKI
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 1:10640 WEST 165 STREET
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-364-0261
Mailing Address - Fax:708-364-0269
Practice Address - Street 1:10640 WEST 165 STREET
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-364-0261
Practice Address - Fax:708-364-0269
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360527202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615936OtherBLUE SHIELD
IL130004857OtherRAILROAD MEDICARE
IL036052720Medicaid
IL211335Medicare PIN
IL130004857OtherRAILROAD MEDICARE
IL01615936OtherBLUE SHIELD
D86695Medicare UPIN
IL215683Medicare PIN
IL036052720Medicaid
IL208306Medicare PIN