Provider Demographics
NPI:1790070258
Name:BURKE-KRIEG, JENNIFER JANEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANEL
Last Name:BURKE-KRIEG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N TOMAHAWK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-8305
Mailing Address - Country:US
Mailing Address - Phone:035-803-4127
Mailing Address - Fax:
Practice Address - Street 1:1 ERIE CT
Practice Address - Street 2:SUITE 6160
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2566
Practice Address - Country:US
Practice Address - Phone:708-763-1490
Practice Address - Fax:708-763-7232
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK146409207Q00000X
IL125059740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine