Healthcare Provider Details

I. General information

NPI: 1053705095
Provider Name (Legal Business Name): JENNIFER KALIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W HARRISON ST STE 466
CHICAGO IL
60612
US

IV. Provider business mailing address

1650 W HARRISON ST STE 466
CHICAGO IL
60612-3800
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number43711
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125072107
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number43711
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: