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NPI Code Detail

MEDICARE: JENNIFER LYNN KALETA D.P.M.

MEDICARE: JENNIFER LYNN KALETA D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0131XFoot Surgery Podiatrist016004910IL
2213EP1101XPrimary Podiatric Medicine Podiatrist016004910IL

General Provider Information

NPI Number : 1225092901
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN KALETA D.P.M.
Provider Business Mailing Address
First Line : 1660 FEEHANVILLE DR STE 450
Second Line :
City : MOUNT PROSPECT
State : IL
Zip : 60056-6023
Country : US
Telephone Number : 847-390-7666
Fax Number : 847-390-9345
Provider Business Practice Location Address
First Line : 24024 BRANCASTER DR
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-8044
Country : US
Telephone Number : 847-390-7666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2006
Last Update Date : 12/20/2021

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