Provider Demographics
NPI:1548311954
Name:REIS, JADER R D (MD)
Entity type:Individual
Prefix:DR
First Name:JADER
Middle Name:R D
Last Name:REIS
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 1:1431 N WESTERN AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7712
Mailing Address - Country:US
Mailing Address - Phone:773-384-8823
Mailing Address - Fax:773-384-8811
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:STE 208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7712
Practice Address - Country:US
Practice Address - Phone:773-384-8823
Practice Address - Fax:773-384-8811
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36077835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077835Medicaid
IL79220Medicare ID - Type Unspecified
ILC51377Medicare UPIN