Healthcare Provider Details

I. General information

NPI: 1972288041
Provider Name (Legal Business Name): JENNIFER ELIZABETH SYKSTUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 S HARLEM AVE
CHICAGO IL
60638-1006
US

IV. Provider business mailing address

5311 S HARLEM AVE
CHICAGO IL
60638-1006
US

V. Phone/Fax

Practice location:
  • Phone: 773-586-0076
  • Fax: 773-586-0052
Mailing address:
  • Phone: 773-586-0076
  • Fax: 773-586-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085011430
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: