Provider Demographics
NPI:1174592810
Name:KIRCHENS, JENNIFER IRENE (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:IRENE
Last Name:KIRCHENS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 N KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4409
Mailing Address - Country:US
Mailing Address - Phone:773-991-4493
Mailing Address - Fax:
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 3500
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-398-8637
Practice Address - Fax:847-398-4349
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005092213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU98491Medicare UPIN