Provider Demographics
NPI:1467506865
Name:JENNIFER IRENE KIRCHENS DPM PC
Entity Type:Organization
Organization Name:JENNIFER IRENE KIRCHENS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:KIRCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-991-4493
Mailing Address - Street 1:1111 S STATE ST
Mailing Address - Street 2:UNIT 404
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3170
Mailing Address - Country:US
Mailing Address - Phone:773-991-4493
Mailing Address - Fax:312-341-1227
Practice Address - Street 1:375 ELM ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4376
Practice Address - Country:US
Practice Address - Phone:847-940-4010
Practice Address - Fax:847-317-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005092213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL98491Medicare UPIN