Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jackson Paul Tate

Individual provider Orthopaedic Surgery Physician · NPI 1164207031

Jackson Paul Tate is an Orthopaedic Surgery Physician in Maywood, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2023
Specialties on file
2

Practice location Address checks out

2160 S 1st Ave
Maywood, IL 60153-3328
Phone: (888) 584-7888
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopaedic Surgery Physician (primary) Taxonomy 207X00000X · Licence 125.085170 (IL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1164207031
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 29, 2023
Last updated in NPPESApril 9, 2025
Certification dateApril 9, 2025
Mailing address2160 S 1st Ave, Maywood, IL 60153-3328

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