Individual
JENNAFER BIRNE OTTENHEIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 N WESTMORELAND RD, LAKE FOREST, IL 60045-1658
(847) 582-2134
(847) 535-7285
Mailing address
1000 N WESTMORELAND RD, LAKE FOREST, IL 60045-1658
(847) 582-2134
(847) 535-7285
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005056
IL
Other
Enumeration date
05/28/2014
Last updated
06/30/2021
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