Provider Demographics
NPI:1215952536
Name:HARRISON, JACQUELINE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LEE
Last Name:HARRISON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:DEPT. OF SURGERY - MC 958
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-9936
Mailing Address - Fax:312-355-3763
Practice Address - Street 1:1969 W OGDEN AVE
Practice Address - Street 2:DEPT. OF SURGERY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3765
Practice Address - Country:US
Practice Address - Phone:312-996-9336
Practice Address - Fax:312-355-3763
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-04-26
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Provider Licenses
StateLicense IDTaxonomies
IL036-097361208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery