Provider Demographics
NPI:1144859406
Name:URBAN, JACQUELINE ANNE (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNE
Last Name:URBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 730
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2990
Mailing Address - Country:US
Mailing Address - Phone:312-695-0070
Mailing Address - Fax:312-926-0239
Practice Address - Street 1:676 N SAINT CLAIR ST STE 730
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2990
Practice Address - Country:US
Practice Address - Phone:312-695-0070
Practice Address - Fax:312-926-0239
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.163726207RC0000X
COTL.0008165390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program