Active NPI
Jennifer Kirsten Kirk, MD
- Surgery Physician
- Carol Stream, IL
National Provider Identifier
1679564397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 036090372
- Practice address
- 630 E North Ave
Carol Stream, IL 60188-2127 - Phone
- (630) 458-5300
- NPI assigned
- Nov 2, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036090372 | IL | Primary |
Addresses
Primary practice location
630 E North Ave
Carol Stream, IL 60188-2127
Mailing address
630 E North Ave
Carol Stream, IL 60188-2127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036090372 | IL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552262400000",
"number": "1679564397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 E NORTH AVE",
"city": "CAROL STREAM",
"state": "IL",
"postal_code": "601882127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 E NORTH AVE",
"city": "CAROL STREAM",
"state": "IL",
"postal_code": "601882127",
"telephone_number": "630-458-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRK",
"first_name": "JENNIFER",
"middle_name": "KIRSTEN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-02",
"last_updated": "2019-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036090372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carol Stream, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.