Provider Demographics
NPI:1679733372
Name:BELLO KOTTENSTETTE, JENNIFER R (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:BELLO KOTTENSTETTE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 ERIE CT STE 4110
Mailing Address - Street 2:WEST SUBURBAN MEDICAL CENTER
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2566
Mailing Address - Country:US
Mailing Address - Phone:708-763-2369
Mailing Address - Fax:
Practice Address - Street 1:14 LAKE ST
Practice Address - Street 2:PCC LAKE STREET FAMILY HEALTH CENTER
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2606
Practice Address - Country:US
Practice Address - Phone:708-383-0113
Practice Address - Fax:708-383-9911
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2013-04-24
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Provider Licenses
StateLicense IDTaxonomies
IL125054977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine