Healthcare Provider Details

I. General information

NPI: 1396715017
Provider Name (Legal Business Name): JENNIFER MARIE OROZCO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER MARIE FREDERICK PA-C

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE#1156
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

600 S PAULINA ST 761 AAC
CHICAGO IL
60612-3806
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-2109
  • Fax: 312-563-4388
Mailing address:
  • Phone: 312-942-5407
  • Fax: 312-563-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number85-002136
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: