Provider Demographics
NPI:1316930068
Name:JAKSTYS, TOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:A
Last Name:JAKSTYS
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 1:76 W COUNTRYSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1967
Mailing Address - Country:US
Mailing Address - Phone:630-553-2722
Mailing Address - Fax:630-553-3983
Practice Address - Street 1:76 W COUNTRYSIDE PKWY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1815
Practice Address - Country:US
Practice Address - Phone:630-553-2722
Practice Address - Fax:630-553-3983
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1921614OtherBCBS
IL036100611Medicaid
ILL79426Medicare ID - Type Unspecified
IL036100611Medicaid