Individual
JENNIFER J. KOTTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4201 W MEDICAL CENTER DR, MCHENRY, IL 60050-8409
(815) 334-5566
(815) 759-4008
Mailing address
DEPT 2018, PO BOX 29675, PHOENIX, AZ 85038-9675
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036139297
IL
2085R0202X
Diagnostic Radiology Physician
28102
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
499378
—
AZ
Enumeration date
05/23/2006
Last updated
11/08/2023
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