Provider Demographics
NPI:1801820691
Name:HOSSO-COOPER, JENNIFER M (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:HOSSO-COOPER
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 1:4301 W 95TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2670
Mailing Address - Country:US
Mailing Address - Phone:708-425-5500
Mailing Address - Fax:708-425-0771
Practice Address - Street 1:4301 W 95TH STREET
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2670
Practice Address - Country:US
Practice Address - Phone:708-425-5500
Practice Address - Fax:708-425-0771
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100719Medicaid
IL570710Medicare ID - Type Unspecified
IL036100719Medicaid