Provider Demographics
NPI:1235660309
Name:JO, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:JO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 18-200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5929
Mailing Address - Country:US
Mailing Address - Phone:312-695-8630
Mailing Address - Fax:312-926-6905
Practice Address - Street 1:675 N SAINT CLAIR ST STE 18-200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5929
Practice Address - Country:US
Practice Address - Phone:312-695-8630
Practice Address - Fax:312-926-6905
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1235660309207R00000X
IL036152273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine