Healthcare Provider Details

I. General information

NPI: 1629204961
Provider Name (Legal Business Name): SARAH JAHNS KIDDER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 75TH ST. SUITE 202
WOODRIDGE IL
60517-2700
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 630-646-6750
  • Fax: 630-548-7654
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number036128700
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125055971
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036128700
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: