1467506865 NPI number — JENNIFER IRENE KIRCHENS DPM PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467506865 NPI number — JENNIFER IRENE KIRCHENS DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNIFER IRENE KIRCHENS DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467506865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 S STATE ST
Provider Second Line Business Mailing Address:
UNIT 404
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60605-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-991-4493
Provider Business Mailing Address Fax Number:
312-341-1227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEERFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-4376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-940-4010
Provider Business Practice Location Address Fax Number:
847-317-2564
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIRCHENS
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-991-4493

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  016-005092 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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