Provider Demographics
NPI:1306926027
Name:HANNIGAN, JEROME J (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:J
Last Name:HANNIGAN
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 1:10323 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1610
Mailing Address - Country:US
Mailing Address - Phone:773-779-8499
Mailing Address - Fax:773-429-9972
Practice Address - Street 1:10323 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1610
Practice Address - Country:US
Practice Address - Phone:773-779-8499
Practice Address - Fax:773-429-9972
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088163207L00000X
IL036.088163207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088163Medicaid
IL036088163Medicaid
ILG56652Medicare UPIN
ILL96895Medicare ID - Type UnspecifiedCOOK COUNTY