Healthcare Provider Details

I. General information

NPI: 1245308873
Provider Name (Legal Business Name): JENNIFER L KURKA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4789 ROUTE 71
OSWEGO IL
60543-4714
US

IV. Provider business mailing address

4789 ROUTE 71
OSWEGO IL
60543-7415
US

V. Phone/Fax

Practice location:
  • Phone: 630-898-5969
  • Fax: 630-898-5837
Mailing address:
  • Phone: 630-898-5969
  • Fax: 630-898-5837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36115418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: