Healthcare Provider Details

I. General information

NPI: 1396480208
Provider Name (Legal Business Name): JENNIFER LEIGH LIBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LEIGH WOJTOWICZ MD

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 04/09/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE. PEDIATRIC HOSPITALISTS
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE. SUITE 1223
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2833
  • Fax: 847-570-1510
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.079712
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036174027
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: