1174592810 NPI number — DR. JENNIFER IRENE KIRCHENS D.P.M.

Table of content: DR. JENNIFER IRENE KIRCHENS D.P.M. (NPI 1174592810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174592810 NPI number — DR. JENNIFER IRENE KIRCHENS D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRCHENS
Provider First Name:
JENNIFER
Provider Middle Name:
IRENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

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:
1174592810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4439 N KEYSTONE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60630-4409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-991-4493
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 W CENTRAL RD
Provider Second Line Business Practice Location Address:
SUITE 3500
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-2355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-398-8637
Provider Business Practice Location Address Fax Number:
847-398-4349
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , 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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