Provider Demographics
NPI:1245308873
Name:KURKA, JENNIFER L (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:KURKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4789 ROUTE 71
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7415
Mailing Address - Country:US
Mailing Address - Phone:630-898-5969
Mailing Address - Fax:630-898-5837
Practice Address - Street 1:4789 ROUTE 71
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-4714
Practice Address - Country:US
Practice Address - Phone:630-898-5969
Practice Address - Fax:630-898-5837
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36115418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46793Medicare UPIN