MEDICARE: DR. JENNIFER BREMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036097704	IL
2	2084P0804X	Child & Adolescent Psychiatry Physician	036097704	IL

General Provider Information

NPI Number	:	1689963316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER BREMER M.D.

Provider Business Mailing Address
First Line	:	5739 S KIMBARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1614
Country	:	US
Telephone Number	:	773-443-3744
Fax Number	:

Provider Business Practice Location Address
First Line	:	5739 S KIMBARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1614
Country	:	US
Telephone Number	:	773-443-3744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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