Healthcare Provider Details

I. General information

NPI: 1881733541
Provider Name (Legal Business Name): JEAN ELLEN BURR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN ELLEN WARDRIP M.D.

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-0001
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9300
  • Fax: 847-723-9583
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01055638A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number01055638A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036170699
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: