Provider Demographics
NPI:1003102948
Name:MOORE, KRISTEN GRABOW (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:GRABOW
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:GRABOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1250 W FULLERTON AVE
Mailing Address - Street 2:APT 3E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2196
Mailing Address - Country:US
Mailing Address - Phone:757-676-3748
Mailing Address - Fax:
Practice Address - Street 1:211 E ONTARIO ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3468
Practice Address - Country:US
Practice Address - Phone:312-694-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-059649207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine