JENNIFER ROSE DEFAZIO (NPI# 1235441429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235441429 |
| Entity Type | Individual |
| Full Name | JENNIFER ROSE DEFAZIO |
| Other Name | JENNIFER ROSE MIKSAN |
| Credential | M.D. |
| Practice Address |
5841 S Maryland Ave Chicago IL 60637-1447 |
| Mailing Address |
3959 Broadway Rm 216b New York NY 10032-1559 |
| Practice Telephone | 7737021000 |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2020-01-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
288868-1 | NY | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255443925 | Jennifer L Defazio | Dermatology | 800 Veterans Hwy, Hauppauge, NY 11788-2948 | 2006-08-31 |
| 1003318056 | Jennifer Marie Defazio | Specialist/Technologist | 4200 5th Ave, Pittsburgh, PA 15260-0001 | 2018-03-06 |
| 1508988742 | Jennifer Marie Defazio | Dermatology | 517 Moye Blvd Fl 3, Ecu Physicians Dermatology, Moye Medical #2, Greenville, NC 27834-2849 | 2007-04-06 |
| Street Address |
5841 S MARYLAND AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60637-1447 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700887296 | Rita Lynn Mcgill | Internal Medicine | 5841 S Maryland Ave, Chicago, IL 60637-1447 | 2005-08-09 |
| 1447851472 | Basirat Sulaiman | Nurse Practitioner | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-11-05 |
| 1982204061 | Martha Daniela Gorski | Nurse Practitioner | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-10-28 |
| 1841807179 | Jason Bugno | Pharmacist | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-09-30 |
| 1942816798 | Emily Mancewicz | Registered Nurse | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-09-17 |
| 1841805546 | Anayeli Locascio | Nurse Practitioner | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-09-10 |
| 1336752856 | Rachel Barsella | Registered Nurse | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-08-25 |
| 1982215620 | Jennifer Risner | Registered Nurse | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-08-16 |
| 1134739857 | Moshe Bedziner | Physician Assistant | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-08-06 |
| 1427676899 | Brittney Blackwell | Registered Nurse | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2020-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386263234 | Pooja Ramnani | Pharmacist | 5841 S Maryland Ace, Chicago, IL 60637 | 2020-04-10 |
| 1780220079 | Tara Coleman | Non-emergency Medical Transport (VAN) | 808 E. 63rd Street, Suite 135, Chicago, IL 60637 | 2019-11-21 |
| 1366003501 | Valerie Silas | Case Management | 6330 S King Drive, Chicago, IL 60637 | 2019-06-27 |
| 1205391620 | Derek Joseph Fiedler | Anesthesiology | University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 | 2019-02-11 |
| 1821573072 | Ugochinyere Ohaja | Registered Nurse | 5656 South Maryland Avenue, Chicago, IL 60637 | 2018-10-03 |
| 1053899138 | Won Hee Oh | Physician Assistant | 5841 S. Maryland Ave., Mc5040, Chicago, IL 60637 | 2018-08-01 |
| 1558854695 | Rasidat Adeduntan | Internal Medicine | 5841 S. Maryland Avenue, [7082], Chicago, IL 60637 | 2018-06-13 |
| 1194235283 | Melissa Ann Arangoa | Registered Nurse | 5841 S. Maryland Ave, Mc 1083, Chicago, IL 60637 | 2017-10-03 |
| 1558880633 | Marni Harris | Optometrist | 5841 S Maryland Ave # S421, Chicago, IL 60637 | 2017-09-11 |
| 1992235105 | Vidya Mahavadi | Pediatrics | 5841 S. Maryland Avenue, Mail Code 8016, Chicago, IL 60637 | 2017-06-20 |
| Find all providers in zip 60637 | ||||
| Taxonomy Code | 2086S0120X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Pediatric Surgery |
| A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417141904 | Erik Ryan Barthel | Surgery | 5841 S Maryland Ave # Mc4062, University of Chicago Medicine, Chicago, IL 60637-1447 | 2007-08-28 |
| 1467666081 | Connie Jean Rossini | Surgery | 1725 W Harrison St Ste 708, Chicago, IL 60612-3841 | 2007-05-10 |
| 1356394217 | Childrens Surgical Foundation Inc | Surgery | 225 E Chicago Ave # 114, Chicago, IL 60611-2991 | 2006-05-19 |
| 1356822050 | Lurie Childrens Surgical Foundation Inc | Surgery | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2018-08-22 |
| 1649774803 | Rachael Sundland | Surgery | 5841 S Maryland Ave # Mc4062, Chicago, IL 60637-1443 | 2018-03-22 |
| 1245746213 | Chicagoland University Pediatric Surgery, LLC | Surgery | 2900 N Lake Shore Dr, Chicago, IL 60657-5640 | 2017-12-28 |
| 1043655285 | Frances Chinenye Okolo | Surgery | 5841 S Maryland Ave # Mc4062, Chicago, IL 60637-1443 | 2013-05-01 |
| 1417226952 | Andrea Yan-sin Lo | Surgery | 5839 S Maryland Ave, Wp C-411 / Mc 4062, Chicago, IL 60637-1463 | 2011-12-28 |
| 1417198318 | Mark Slidell | Surgery | 5841 S Maryland Ave, M/c 4062 C411, Chicago, IL 60637-1447 | 2009-03-23 |
| 1912147349 | Yue-yung Hu | Surgery | 225 E Chicago Ave # 63, Chicago, IL 60611-2991 | 2009-02-25 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.