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General NPI Number Information
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NPI Number | 1649444225
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Entity Type | Organization
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Legal Business Name | JENNIFER L KALETA DPM, LTD
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 3000 N HALSTED ST STE 625
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City | CHICAGO
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State | IL
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Zip | 60657-5196
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Country | US
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Telephone | 773-868-4701
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Fax | 773-868-4702
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Provider Business Mailing Address
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Address Line | 1929 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60613-1011
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Country | US
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Telephone | 773-868-4701
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Fax | 773-868-4702
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Authorized Official
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Title or Position | OFFICE MANEGER
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Name | MS. DIANA WALAS
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Credential |
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Telephone | 773-868-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-004910
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License Number State | IL
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