Healthcare Provider Details

I. General information

NPI: 1407864077
Provider Name (Legal Business Name): JENNIFER LYNN SUFFERN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST ORTHO OFFICE ROOM 657
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

16834 HILLTOP AVE
ORLAND HILLS IL
60477-6032
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-5365
  • Fax: 312-864-9755
Mailing address:
  • Phone: 708-364-1384
  • Fax: 312-864-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016-005076
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number016-005076
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: