Individual
JENNETTE LATRESE BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10242 S VINCENNES AVE, CHICAGO, IL 60643-1301
(773) 238-1676
(773) 238-1641
Mailing address
20110 GOVERNORS HWY, OLYMPIA FIELDS, IL 60461-1030
(708) 747-7960
(708) 503-3993
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036111987
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111987
—
IL
01
—
P00266812
R/R MEDICARE
—
Enumeration date
08/31/2006
Last updated
12/17/2021
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